The Tim Ferriss Show Transcripts: Peter Attia, M.D. — Fasting, Metformin, Athletic Performance, and More (#398)

Please enjoy this transcript of my interview with Dr. Peter Attia (peterattiamd.com, TW: @PeterAttiaMD, IG: @peterattiamd, FB: @peterattiamd), a former ultra-endurance athlete, 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.

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. He 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.

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#398: Peter Attia, M.D. — Fasting, Metformin, Athletic Performance, and More
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Tim Ferriss: Well, hello, boys and girls. This is Tim Ferriss, and welcome to another episode of the Tim Ferriss Show. I am here with — some might mistake him as Borat. Sample:

Peter Attia: A man is like a horse. We say in Kazakhstan, if a man is happy, you know happy, is a like if a horse is happy.

Tim Ferriss: But on the internet, and in his clinical duties, he’s known as Peter Attia. Dr. Peter Attia. Welcome back to the show.

Peter Attia: Thank you. Thank you for having me.

Tim Ferriss: And Peter, for those who do not know anything about your background, we’ll cover just the basics, but what would be a kind of speaker bio short version of Peter Attia, just to get people up to speed who have not heard previous episodes?

Peter Attia: Part-time shepherd, part-time race car driver, part-time archer, part-time doctor.

Tim Ferriss: And that pie chart has most of the pie on doctor. What else do we have here? 

Peter Attia: Doctor interested in longevity. I guess I have to do all the serious stuff now. Podcast host, courtesy of you. The podcast is called The Drive, and it focuses on things beyond driving. Mostly, I guess, things related to longevity. And Dad. I guess that’s another thing on the bio.

Tim Ferriss: Another responsibility. And for those who have not heard our prior conversations, Peter is my go-to resource for anything related to extension of lifespan, or more accurately, health span. So threading the needle of combining both longevity and performance, and that’s across many different dimensions. We’re probably not going to spend all of our time on that today.

But Peter is one of the most methodical, and oftentimes, obsessive people I’ve ever met. And that’s coming from me, keep in mind. So I think it was in episode one that we talked about, so we’re not going to spend time on it now, but Peter’s very, very, very particular etiquette for stapling, which has measurements in the metric system, and so on. So we’re not going to get into that.

But Peter is my de facto expert when it comes to many different things, including longevity. And one of our episodes, which was a group episode with two other very, very accomplished scientists, was actually recorded on Easter Island. As a teaser for people who might want to explore, which is known as Rapa Nui, and is the namesake from which rapamycin is named, which we may talk about. And there you have it for preface to our conversation.

But we’re going to try something today which is a first, and I think we’re going to call it, temporarily, Five Things with Peter Attia. It might end up being more than five, but I know Peter pretty well, and Peter knows certainly me quite well. I said, “What do you think of doing an episode where we talk about, say, five things that you’re excited about currently, five things you’ve changed your mind on in the last whatever it is, a year, two years, three years, whatever, and then five absurd or stupid things that you do or still do. And we’re going to give that a shot. And I think we’ll maybe cycle through. Do you think we should do the five excited, five change, five stupid in that grouping, or should we do one, one, one, and kind of cycle through?

Peter Attia: Ooh, that’s a good question. I don’t know. I was all mentally prepared to go from one category to the next. So I would suggest do the opposite of what I was prepared for.

Tim Ferriss: Perfect. Let’s cycle through. So what is the first thing you’d like to confess or describe that you’re excited about?

Peter Attia: So the first thing, and I guess for the listener, you were very kind enough to give me a heads up that this is what you wanted to talk about. So I actually did have some time to think about this, which fortunately allows me to not sound like an idiot, which is what I would have sounded like if you had just asked me this cold.

So the first thing I have on my list about excited stuff is the Centenarian Olympics, which is my favorite sport. It’s the sport that I am exclusively training for, and it has become one of the highest priorities within my medical practice in the past probably two years.

So the idea is the following. I had this, I think I can call it an epiphany actually, maybe 18 months ago to two years ago. I was at the funeral of the parent of a close friend. And like all funerals, there’s a somber nature to them, but on some level, people are also generally rejoicing in the fact that a person hasn’t suffered too much. And in the case of my friend’s parent, who had been diagnosed with Alzheimer’s disease, the time from diagnosis to death was like six months. And everyone was like, “Ah, that’s great.” There wasn’t much suffering there.

But I knew that parent for many years. And what I realized in spending more time talking with everybody was that the last 10 years of their life, even though their brain was still intact, shy of the last six months of that 10 years, the body had broken down. And the two things that gave that person the pleasure, beyond spending time with their grandkids and things like that, which was golf and gardening, like landscaping, really some killer landscaping were basically off the table, courtesy of hip injuries, shoulder injuries, back injuries, all these other things.

And so I sort of reflected on this for a while and realized that’s pretty much the standard path that people go on, which is before they actually die their physical death, the sort of what I call death certificate death, they tend to die some combination of a cognitive and physical as an exoskeleton death. And so we’re sitting there at the funeral, and I don’t know, I’m just thinking there’s got to be a way to stop this. Because nobody’s really thinking about this. We do all this amazing training for athletes who are trying to go to the Olympics, or even being weekend warriors, or doing whatever they’re going to do.

But why aren’t we training to be kick ass 90-year-olds? So my hypothesis was, well, it’s just a lack of specificity. I mean what separates a professional athlete from a weekend warrior is generally the specificity and the intensity with which they pursue this thing. So I said, well, what if we came up with an event that actually defined what one would want to be able to do when they’re 100, using that just as a benchmark. You may never live to 100, but to train to achieve this thing when you’re 100 you’ll obviously be in great shape when you’re 80.

And so I sort of came up with the city of the Centenarian Olympics. And the first thing you’ve got to know about the Centenarian Olympics is it’s very personal. It’s individual. Everyone will have a different set of events. So you and I might have a different looking Centenarian Olympics, though I think there are some common things to all.

So the first thing I did to figure this out was I, for myself, which is the person I’m solving for in the first iteration is sort of mapped out how old everyone in my life would be when I’m 100. So how old would my kids be? How old would their kids’ kids be? And all the way down. And that gave me kind of a mental model of what the world looks like when I’m in my 10th decade.

And what I realized is the things that are probably going to give me the greatest joy at that stage will involve interacting with those littler people. And my kids won’t be that little, there’ll be in their 60s or whatever, but their kids will be in their 20s and 30s, and their kids’ kids will be basically the age of my youngest kids now.

And so I just started paying more attention to what I do with them. And it’s stuff that, Tim, you and I would take for granted. I’m guessing anybody listening to this is going to take it for granted. But kids, you’ve seen my kids a million times, they play on the floor. So step one, can you get up off the floor? Can you lay on the floor? Can you do something on the floor? And can you get up under your own support? Again, you could do that blindfolded today, but watch how many people even in their 60s, let alone 70s and 80s, can’t do that. And then you start to deconstruct why. What are the structural misgivings that prevent someone from doing that?

Another thing I noticed is how often toddlers come running at you head first, and they don’t actually stop when they get to you. So there’s an implicit assumption that as they’re running to you, you’re going to be able to pick them up and stop that momentum. And if you can’t, you’re going to get a headbutt to the groin. So that’s a very essential part of the equation here. So I started saying, well, how many times does my son, my youngest son, come running at me and how often do I have to drop down into a goblet squat, grab him, and pick him up.

And so basically I listed out 18 things that I can do today that I want to be able to do when I’m 90, for example. And those events constitute my Centenarian Olympics. And so I’ll rattle off a couple of them, but a 30-pound goblet squat. Again, could you do that today, Tim? Yeah, you could do 100 of those today. But how many 90-year-olds can do that? Very few. Walking up three flights of stairs with 10 pounds of groceries in each hand, and walking down under the same load. Again, biomechanically that’s not a trivial task. The walking down has its own challenges. The walking up has its own challenges.

Being able to pull myself out of a pool where the gap between the water and the surface, the lip of the ground, is six inches away. So being able to actually pull myself up. As I said, getting up off the floor with a single point of support, being able to put a 30-pound suitcase over my head, all these sorts of things.

Tim Ferriss: Which would simulate putting her luggage into the overhead.

Peter Attia: Exactly. Again, I don’t want to get to the day when I can’t put my luggage above myself in the airplane. And once I sort of mapped out all these things, I kind of broke down what the movement patterns that were necessary to do this. So this requires the ability to hip hinge. This requires a certain amount of aerobic efficiency. This requires a certain amount of anaerobic efficiency. This requires a certain amount of scapular stability, et cetera, et cetera.

And they basically condense into four elements of health, which is stability. So the ability to, using the muscles of the body, control the exoskeleton, such that load is transferred safely through muscles as opposed to unsafely, not joints, strength, aerobic efficiency, and anaerobic performance.

And then you back out of that and say, well, if you want to be able to do all of those things by the time you’re 100, or say in your 10th decade, so between 90 and 100, what do you need to be doing when you’re 70? Because there is going to be an inevitable decline from 70 to 100. And if you can do this metric at 70, what do you need to be able to do at 60, and what do you be able to need to do at 50. And since that’s the decade I’m closest to, I’ll be 50 soon, that becomes my benchmark is, okay, so that’s what I’m training for.

And so this idea we’ve sort of translated to our patients, which is unless you really have a strong desire to do an iron man, or run a marathon, most people are exercising without a real sense of purpose. And so the question is, could you create a true sense of purpose around this and then work backwards to build towards it? And obviously we’re not going to know the answer to that question until people start getting there, but my strong belief is you can and you should. And if you do this, if you just assume by chance you’re going to get there, I think the likelihood of that is low.

Tim Ferriss: And if we look at one of those exercises, and you can pick anyone, let’s just take the goblet squat to simulate picking up a toddler. How do you back out from doing that at 90 or 100 with 30 pounds? Do you assume a certain amount of sarcopenia, is that the right word, muscle loss per year from 70 to 100, and then somehow calibrate a much higher weight for a certain number of repetitions as a result? How do you think through that calculus?

Peter Attia: It’s exactly that. So it’s not rocket science to figure out a 30-pound goblet squat at 90 equals how many pounds at 50. The bigger question is to understand how you have to do it biomechanically at 50 to ensure you can still even do it safely at 90. So let’s just say the number’s 90 pounds at 50. It’s not that hard to goblet squat 90 pounds for a fit guy like you, but it’s actually kind of hard at our age, or anybody’s age frankly, to do it perfectly, especially with complete scapular protraction. Which is another thing you want to be able to do because remember you’re holding a toddler here, so you need to be completely stabilized through the upper and lower body. And the thing that’s nice about a goblet squat, just as one example — 

Tim Ferriss: Do you want to just describe a goblet squat to people for those who don’t know? I mean, you could use a kettlebell as an example or something else.

Peter Attia: Yeah. Yeah. So if you’re picturing holding a dumbbell or a kettlebell, and you have both hands on it and it’s in front of you, and you’re going into a squat position that way. So as opposed to a barbell squat where the bar is on your back and you’re holding it back. The nice thing about this goblet squat is it’s a little bit more representative of real world movement because you now have your scapula that have to move forward. That’s called protraction. And you have to be able to stabilize that position, which is going to be holding the kettlebell, or the dumbbell, or the child.

Tim Ferriss: Or if you’re our friend Kevin Rose, you want to be able to throw a raccoon at 90. Also helpful. For those who haven’t seen, we don’t have to get into it. There’s a great video of Kevin Rose throwing a raccoon. You can look it up. Back to the children and the goblet squat.

Peter Attia: Yeah. So, and then of course you get into the real minutiae of what does it really mean to be able to squat safely. And again, for most people, myself included, before I was really putting a lot of thought into this, to do a heavy hip hinge activity like a squat or a deadlift, you will naturally tend to fall into a place of lumbar compression. You will compress the spine when you do these things. That’s not that sustainable.

What you really want to be able to do is get to a point where you can do those things under spinal traction, which sounds very counterintuitive. Most people think of traction as something you can only achieve when you hang, which is elongating the spine. But it turns out if you generate concentric intra-abdominal pressure from diaphragm to pelvis, you can actually stretch out the spine while you’re under load.

And once you start doing it biomechanically correctly at the age of 40 or 50 or whatever, and you start to carry that forward, then you’re sort of winning on two fronts. With the more important of those being by the time you get to 90, you actually have the ability to even move in that direction and stabilize your trunk, which is the rate limiting step for a squat.

Tim Ferriss: It seems like with many of these movements, and I suppose in many things in life, if you want to play the long game, you kind of have to check your ego at the door, right? Because you would probably be making some trade-offs in terms of the amount of weight you can lift, et cetera, if you’re going to be training technically to be able to perform these movements at 90, right? If you’re not going to be doing a wide power lifter squad with a limited range of motion compared to say an Olympic ass to heel squat, very different in terms of biomechanics and what you can do.

Peter Attia: I mean I work with three people, a woman named Beth Lewis, a guy named Michael Stromsness, and another guy named Michael Rintala, and all of them have a training in something called dynamic neuromuscular stabilization or DNS. And then they all of course bring in their own expertise outside of that from powerlifting and other athletic disciplines.

And Beth, who’s sort of the one that kind of defaults into my deadlift program. So I deadlift twice a week, and we started from scratch. So we have basically, imagine I’ve never deadlifted, even though I started deadlifting at the age of 15 and powerlifted all the way through high school, her view is no, we’re starting from scratch. It’s as though you’ve never done this before.

And one day a week I’m doing straight bar, very traditional, closed leg, straight bar, deadlift. And I mean she had me starting at 105 pounds. And I was not allowed to progress from that for a couple of months. And I was like, “Beth, at least let me just get to 135 so I can use the goddamn 45s on the side of this thing. I mean, it’s getting ridiculous here.” And she’s like, “No, you’re not ready yet.” And so — 

Tim Ferriss: I’m just imagining a row of like five or 10 pounds plates with the bar, knuckles scraping the floor.

Peter Attia: So, well, luckily we had 10-pound jumpers.

Tim Ferriss: I’m just kidding. I’m kidding.

Peter Attia: So we were juxtaposing the straight bar deadlift with very light weight, and she was letting me use more weight on the hex bar, but we had to fix a whole bunch of movement defects.

Tim Ferriss: Hex bar, for those who don’t know, also known as a trap bar. So called, in the former case, because it is a hexagon that you step inside of so that effectively the bar path is traveling through the central line of your body.

Peter Attia: And so the hex bar is much easier to deadlift because you are in a more advantaged position, but it’s also easier to do incorrectly. And the reason for that is you don’t have a bar in front of your shins. And so if you’re like me, you tend to default into a very quad dominant deadlift.

And what Beth realized was we had to break that cycle, and the only way we were going to get you to use your hamstrings, Peter, is if we changed your position. And the idea was the best way to change your position was put a bar in front of your shins that you can’t go through. So anyway, that’s one example.

But yeah, to your point about checking ego, so much of what I do these days in the weight room looks really silly, and it’s not using nearly that much weight. I mean today you should’ve seen me. What I was doing in the gym today was sort of comical to watch. A lot of single arm pressing in positions that are really forcing me to generate the right amount of concentric force inside my trunk.

Tim Ferriss: And when you say concentric force in the trunk, what do you mean? Because I’m familiar with concentric, eccentric as thought of say in a bicep crawl with lifting the weight, in this case contracting, concentric movement versus eccentric lowering — 

Peter Attia: Yeah. Yeah. Picture somebody putting a balloon inside your belly. Let’s pretend for a moment they could strip all your guts and liver and everything out, and you could put a cylindrical shaped, but round top and round bottom balloon inside your abdomen. So at the top it’s mimicking sort of the shape of your diaphragm. And at the bottom it’s sort of the shape of your pelvis. And then the idea is you sort of start to blow that up and you generate this pressure that comes out. So all of the muscles are sort of getting longer and under more tension. And the force is sort of uniform all the way throughout.

And that’s called intra-abdominal pressure, or IAP. And what I’ve realized over the past little over a year now is most of us have lost the ability to put air into our pelvis, or put pressure really is the right way to think about it. You’re not literally putting air in your pelvis. The air doesn’t go below the diaphragm. But we don’t know how to generate that pressure in the abdomen.

And by being able to do that, that’s what enables you to actually stabilize your spine. So people say to me all the time, “I can’t believe you would deadlift like that, seems so crazy. Aren’t there better ways to get the same activation of the muscles in your glutes, or hamstrings, or quads?” And the answer is yes and no. I mean you can certainly do those things without having to go under that load. But a deadlift is an amazing audit, as is a squat for that matter. And I think of those things as audits because if you’re doing them correctly, and once you learn the appropriate receptive cues that you’re supposed to feel, you know when you’re having a good day and a bad day. If you’re having a good day, that’s the feeling you want to replicate.

Tim Ferriss: Yeah. Audits. There are quite a few movements that act as good audits. Turkish get up, also a nice little audit. For another day perhaps. So let’s, I’m kind of doing the math here, I’m like, all right, if we have 15 or 17, it’s going to be a long podcast. But let’s put a bookmark in the Centenarian Olympics, which we might come back to. You never know. Something you’ve changed your mind on.

Peter Attia: So in no particular order other than the order I listed these things out, the use of metformin in very healthy individuals is something I’ve changed my mind on. So I don’t think we talked about this on any of our other podcasts.

Tim Ferriss: I don’t think so. So yeah, what was the previous position or conclusion, and then — 

Peter Attia: So my 2010 view, which sharpened and became more and more bullish from say 2010 through 2015, ’16, was that metformin was a very, very low risk cancer mitigating drug in anybody. Now I believed that it was more so in patients who had diabetes or conditions that approximated diabetes like hyperinsulinemia. But the data were, I think, quite convincing to me. And my extrapolation was, well, even in people who don’t have diabetes, this is still a great longevity agent.

Tim Ferriss: And for those who don’t know, what does metformin do?

Peter Attia: Well, that’s it.

Tim Ferriss: I guess a big question.

Peter Attia: Yeah. And that’s part of the rub is metformin does a lot of things. It’s a mild mitochondrial toxin, and this becomes relevant to the story. So it sort of inhibits the first complex of the mitochondria, what’s called complex one. And by doing so, and it seems to do so, I mean, preferentially in the liver, it leads to a cascade of events that activates an enzyme called AMP kinase.

And when you do that, the body basically starts acting like it’s in a fasted state. So it’s sort of like a junior fast in a pill. And for people with diabetes, what’s beneficial about it is it lowers the amount of glucose that the liver puts into circulation. So there’s plenty of benefit to that. And there’s no disputing its efficacy there.

And in the last five years, frankly, it’s become a very popular topic. And I’ve interviewed a guy named Nir Barzilai on my podcast and we’ve talked exclusively about this. Nir is one of the world’s experts on metformin. And he’s leading the charge to do a very large clinical trial to test the question of whether metformin is a longevity drug in non-diabetics.

Anyway, the point is, my baseline view was that this is the case, and I had been taking metformin since 2010. What changed a year ago was I began doing a very focused type of exercise that was geared towards mitochondrial performance and efficiency, something called zone two training. Where you basically push the boundaries of how much work you can do while keeping lactate below two millimolar. So lactate is a byproduct of metabolism under conditions in which you’re asking the body to make ATP, which is the energy currency, at a rate faster than can be sustained aerobically using oxygen only.

So by pushing the boundaries of how much work you can do, and I mean work in the very technical sense, so how fast you could run, how many watts you could push on a bike, and ratcheting up that level while still keeping lactate below two, you’re training your mitochondria to become more and more efficient.

And what I started noticing when I was mucking around with different drugs was whenever you have metformin in your system, that output goes down. And again, when you thought about it for a minute, that shouldn’t be surprising. It’s a mitochondrial toxin.

Tim Ferriss: Could you, just don’t lose your train of thought, but what are mitochondria? Fucking fascinating. But mitochondria are, I think, really, really interesting. I don’t want to take us off the rails.

Peter Attia: Yeah. They do a lot of things, but for the purpose of this discussion, what they do is they do the most efficient form of energy transfer, which is transferring energy that comes in the chemical form of energy of like food energy, right? So when you eat something like glucose or fat where your body breaks down and gives you glucose and fat, how do you turn the energy that is stored within those chemical bonds, the carbon carbon bond, the carbon hydrogen bond, et cetera, how do you turn that into ATP?

And you do that by first breaking those things down and getting electrons into these electron donors. And people who might remember from a high school class, something called the electron transport chain that runs through the mitochondria. And those electron donors eventually donate back, make an energy gradient that makes ATP. And in the end, all they spit out is carbon dioxide and water. So that’s why we breathe out carbon dioxide and water vapor in exchange for taking food and making energy.

So they play an essential role, obviously, in energy production. And if you lose the ability to make energy with the mitochondria, that’s effectively what happens to a cancer cell. So this idea of zone two efficiency is so important for metabolic health that I started questioning, well, why the hell would metformin be a good thing if it’s impairing that?

And basically after doing a lot of experimenting with and without metformin, metformin under different clearance pathways, et cetera, et cetera, it became unambiguous to me that metformin was impairing this. And there was no two ways about it. And then I began to question, well, how would you reconcile that with the fact that metformin is helpful? And then you realize, well, metformin’s only really ever been shown to be helpful in people who have diabetes.

And when you look at the sort of mitochondrial performance of people with diabetes, it’s abysmal. In fact, even though that’s not a hallmark that the medical system would typically pay much attention to, but if you do that type of zone two testing in people with diabetes, it’s such a contrast between them and someone without diabetes. So I realized, well, maybe when your mitochondria are that sick, a little bit more toxicity doesn’t matter that much. But if you’re playing a different game, it might.

Now, since that time, a number of other studies have come out. I’ve written about one of them, or maybe actually two of them, that look at the effect of metformin and mitochondrial inhibition on the difficulty of growing muscle mass. Which again is not as interesting to me, but that appears to be a totally different issue, which is the blocking of sort of the stress response. I think the jury’s still out on all this — 

Tim Ferriss: Meaning that metformin appears to inhibit versus not in an administration of metformin — 

Peter Attia: Correct. That’s right. Metformin seems to impair the sort of the inflammatory response that would be pro growth to muscle, pro adaptation, for lack of a better word. I think it’s still too soon to say how this story shakes out. But basically in the past year, I’ve seen enough data to suggest that, for me personally, the benefits of just focusing and doubling down on my exercise are probably going to yield better results than the use of metformin.

And of course then the question is how do you translate that into patients, and where do you draw that line? Which patients are sufficiently on the healthy enough side? And I don’t know the answer. I think my thinking on that is the more you exercise and the healthier you are, the less benefit and potentially the more detriment you could experience from metformin.

Tim Ferriss: I mean, I suppose, this is not Tim playing a doctor on the internet, but just thinking about that, that even if someone were say pre-diabetic or presenting the symptoms or biomarkers of someone who is pre-diabetic, it might make sense to try other interventions before metformin, right? Because you might slap on 10 pounds of muscle mass, and lo and behold, they’re much better at disposing of glucose, or any number of things could change.

Peter Attia: I think no matter what, like if you take somebody who’s got diabetes, I don’t think people appreciate how potent a tool fasting, exercise, and sleep are. You know when you rob someone of sleep, when their sleep sucks, when they’re not exercising, and when they have full stores of glycogen in liver and muscles, which is basically the state you’re in when you’re constantly fed, the ability to reverse those three things is more powerful than all drugs combined, I mean.

So I agree. If there’s a way that you can treat patients without using medication, one should always do it. Sometimes metformin does offer a great step forward. And again, it comes down every patient’s ability to sort of adhere to exercise and all these other things.

Tim Ferriss: Would you ever consider using metformin? Maybe this is more a job for acarbose; is that — 

Peter Attia: Yeah, you remember that.

Tim Ferriss: — but using say, metformin selectively when you’re going through a period of overfeeding for some purpose?

Peter Attia: I mean, those are exactly the kind of questions I’m still struggling with, which is does it make sense to cycle metformin? Does it make sense to only use metformin in the evening, but not use it in the morning? So let’s say in the morning, you exercise, but in the evening when most people are fed — like for one of the things I did notice when I stopped taking metformin is definitely my nighttime glucose levels are just a little bit higher. Because nighttime glucose is controlled by the liver. It’s not really a function of what you just ate. You’re so far outside of that last meal that it’s generally the response of the liver putting glucose in circulation and titrating that. So yeah, I think they’re probably different, like five different ways that you could sort of slice this thing up and decide on how to do it. And I don’t know the answer and I guess I reserve the right to change my mind again. But for now that’s been a pretty big change for me.

Tim Ferriss: Absurdity, stupidity. I know we have a wealth of options because you and I are connoisseurs of the absurd.

Peter Attia: So one of them, which is the one that you already know about and I know you’re a big fan of is egg boxing. I just cannot get enough of egg boxing.

Tim Ferriss: Oh God, where do we even go with this? Because this could be a podcast in and of itself. But I don’t think we have time to tell the story. If people look it up or we can link to a video of the Ramanujan of egg boxing. But that is maybe a story for another time, which really does put into concrete terms, just how ridiculously obsessive Peter can be. But what is egg boxing?

Peter Attia: So it’s a sport/game where whenever you’re making something with eggs, you hold an egg, you hold another egg, you bang them off each other. The one that cracks you obviously break. And the one that didn’t crack, that’s considered one win. Let’s say these are two eggs you’ve never touched before, you smash them, that that guy is now 1-0. And then you pick up another egg. Let’s say you want to make five eggs and you smash and let’s say that guy wins again. So he’s now 2-0. Then you smash it again and let’s say he loses, well then he retires with a record of 2-1 and the other guy is now 1-0. And you keep going. And at the end, when you break your last egg that day, you write down how many wins the last guy has.

Because by definition the last one standing is always the winner. And then the next time you come to make eggs you just play again. And so I don’t know when I started playing this game, but it was somewhere in high school and I’ve never stopped, and I take it very seriously and I guard the champion very closely. And as you’re alluding to, there was one very, very special egg in my life in 2007 and 2008 who I nicknamed Ramanujan after the great mathematician. Not a great boxer, but he was such a prodigy — 

Tim Ferriss: But a terrible boxer.

Peter Attia: But he’s the only egg I’ve ever had where his winning record was so great that I lost track of his actual record.

Tim Ferriss: Was it in the hundreds, thousands?

Peter Attia: Oh, put it this way, he was the champion for more than a year.

Tim Ferriss: All right, we’re going to continue on to future bullets. But I will say if my memory serves me correctly, that at one point you were like, I want to know what type of strange abscess or structural abnormality exists in this egg, but you couldn’t get someone to agree to X-ray the egg for you so you snuck it into your pocket.

Peter Attia: Well no, the plan was I was going to go to the ER and pretend I had a groin injury and have them do a CT scan of my pelvis with Ramanujan in my pocket because I wanted to see what was really going on inside of him.

Tim Ferriss: And alas, we shall never know. Died a tragic death.

Peter Attia: He died an awful tragic death that I might explain in the video. Okay.

Tim Ferriss: We’ll link in the show notes to the video, which includes a demonstration of the proper technique for egg boxing.

Peter Attia: And I don’t know if you know this, but Nick Stenson, who works for me in the podcast, actually built championship belts for the eggs.

Tim Ferriss: Oh I saw them, I remember voting on what the championship belts should look like. Just right.

Peter Attia: That’s right. So now we have championship belts for my eggs and it’s one of those things people always say, “Peter, when are you going to start making swag for your podcast?” The first piece of swag I would ever make would be championship eggs or the championship belts for the eggs.

Tim Ferriss: Well, you know, I should give you credit where credit is due. You have introduced me to a number of people who’ve been on this podcast including Jocko Willink, who is a master of merch, no big surprise, great at execution, and I’m thinking that you might even be able to create the equivalent of the celebrity bobblehead dashboard for your dashboard craze by having particular personalities represented in the world of egg boxing. You could have a Jocko egg boxing iteration of some type. You’d have to clear it with the big man himself obviously.

Peter Attia: I’m literally going to call Jocko tonight and actually, I love the idea.

Tim Ferriss: All right, we’re back. I like this cycling through. I think we should go back to excited about.

Peter Attia: Okay, the next thing I have on my excited list is just overall the space of fasting and the potency of fasting. But it’s taking a page out of your playbook, right? So the work that you’ve done recently with Johns Hopkins is basically, and I was talking about this with a bunch of people today at the race and they were like, “What is Tim really excited about these days?” And I said, “Well —” and I walked them through your thesis.

Tim Ferriss: In context, by race we mean F1 here in Austin. And if you don’t know anything about F1, just consider this. Top cars have, what is it, 500 million behind them, put into them, teams of hundreds. I mean it’s — 

Peter Attia: Oh yeah, $500 million a year budget easily. Then a team of a thousand.

Tim Ferriss: So, all right, so continue. Didn’t mean to interrupt.

Peter Attia: So what I realized is, and I’ve vented about this many a time. In fact, I have an entire Sunday email devoted just to my vent on this, which is, it really bothers me that we don’t, if fasting is such a potent tool and I don’t think anybody who’s studied nutrition or biochemistry would disagree with that, It’s odd we don’t know how to dose the tool. And so as you know, Tim, I fast for about seven days a quarter.

Tim Ferriss: And this is how it ties into the Hopkins, is the question of dosing?

Peter Attia: Is the question of studying something is basically taking yes. So, so, so it’s basically saying, okay, I fast seven days a quarter and people ask me, rightfully so, “But Peter, how do you know to do that?” Someone will say, “Well, I fast three days a month,” and that’s a comparable number of days, total days fasted. But what’s producing the ideal physiologic response that would lead to life extension or at a minimum reduction of disease risk. And again, it bothers me greatly that I don’t know that. So it occurred to me that what we need to do is form a little coalition and a number of my patients have already said, “Oh, sign me up, I’m in,” and we’ll basically put a pot of money together and find the best people who understand and can help us pick the right animal model because we’re not going to be able to study this in humans.

You have to accept that we’re in the option B territory. There is no option A, there’s no “Let’s do this experiment in humans and study them for 20 years.”

Tim Ferriss: That’s because it wouldn’t get cleared by the IRB — 

Peter Attia: It would take too long.

Tim Ferriss: Just takes too long.

Peter Attia: If you want a hard outcome, which is actual mortality, you have to do this in an animal model.

Tim Ferriss: Yeah, agreed. Okay, I missed that last part.

Peter Attia: Yeah. So, so should it be mice? Well, mice have the advantage of being really easy to study and you could probably know the answer in a year and that might be the answer, but it will require people really smart to understand what the equivalents are for mice in fasting. And it’s not going to be a linear extrapolation from our humans. Like for example, a mouse that fasts for two days dies and loses 25 percent of his body weight directionally. So that’s not going to be that helpful.

Tim Ferriss: But you’re thinking ostriches.

Peter Attia: I have no idea what it is, ferrets. I don’t know. But what I really want to do is in the next couple of years come up with the next best answer. And until that time, unfortunately, I’m going to continue to flail, which means I’m going to continue to fast but do so without much real insight about what the “best way” to do it is. Or if regimen A is better than regimen B. But I think this idea of just saying, you know what, look, NIH is probably not going to fund this, because I don’t think this is a question they’re that interested in. Industry is not going to fund this because you can’t sell a fast. VCs aren’t going to fund — when you look at all of the traditional funding vehicles that would go into exploration of question, this one really has to come down to philanthropy and I have no interest in creating an organization to do this. So why not just bring a coalition of people together, find the right people and just directly fund them.

Tim Ferriss: What would the study design look like?

Peter Attia: So let’s just say, and again, I don’t know if you would do this, but let’s just say it was agreed upon that mice would be an appropriate model. And let’s just say that you agreed that there would be three arms, right? One arm would be mice that were on regular mouse chow and it would be important that it would be proper chow, not nonsense chow. A lot of these studies are done with pure sugar, high fat nonsense chow. The goal isn’t to do that. The goal is to take healthy mice, and then picking the right strain is in itself a huge decision that would have to go into this. So you have the ad lib feed. So these are the mice that are allowed to eat normally.

Tim Ferriss: Yeah. Ad libitum?

Peter Attia: Yes. Then you’d have probably — 

Tim Ferriss: Which means they can eat as much as they want.

Peter Attia: That’s right. And you have to be very careful about what that looks like by the way, in animals in captivity. So you might have to actually put them on a confined number of calories and maybe it’s not ad lib. And then you’d have different fasting regimens. So you’d have the equivalent of three days a month. What does that look like? I don’t know, that probably works out to be something like eight to maybe eight hours of fasting, 16 hours of food exposure. I have no idea. And then there’s the, well, what does seven days a quarter look like? Or nine days per quarter?

Tim Ferriss: And those are contiguous days.

Peter Attia: Yes. And then maybe you’ve got the whopper, which is like once a year they just do a mega fast, which for a mouse would probably be 24 hours. And then the idea would be, follow them over the course of their lives. And if you can pick a mouse that’s like 12 months old at the outset, you probably know your answer in about a year and a half.

Tim Ferriss: What are the outcome measures or what would you be tracking?

Peter Attia: The most important one would actually be death, would be lifespan. But if we could gather other indirect measures, disease specific measures, depending on the budget for such a study, if we could also shotgun and look at some metabolomic proteomic signals as well, that would be especially interesting, because the only way we would ever triangulate on this in humans would be to look at biomarkers in humans that are surrogates of good things happening.

So things like autophagy, the inhibition of senescent cells, reduction of inflammation in areas that we don’t really want it to be in. So those would be the two prongs of this thing, which is get the hard outcome of mortality in the animal model. Try to get some biomarker data. And again, like I said, when you think about how potent fasting is as a tool that we don’t know what the dose is. It’s like I’ve got this thing, it’s called Tylenol and I know it reduces fevers and prevents muscle soreness. How much do I take? I have no idea. Think of how frustrating a problem that is.

Tim Ferriss: Especially with that example. Very dangerous problem to have. What does your current fasting look like in the sense of timing? Is there a particular day of the week that you tend to start on and how do you lead from whatever your current normal is into the fast?

Peter Attia: So for the past couple of years I’ve done the same thing once a quarter. I think Bob calls it the KFK nothingburger. So it’s a week of keto that leads into a week of water-only fasting that is sandwiched on the other end or bookended by another week of keto.

Tim Ferriss: Is the keto hypocaloric, is it isocaloric?

Peter Attia: It’s a eucaloric ad libitum keto diet. So the purpose of it on the way in is generating ketones so that when you enter the fast you suffer a little bit less. The rationale on the way out is to prevent me from eating like an idiot.

Tim Ferriss: Sorry, which — 

Peter Attia: Can you relate to them?

Tim Ferriss: I can relate to that. And we’ve done a lot of damage together. Just hearkening back to our fantastic trip to Easter Island with — 

Peter Attia: I don’t think we said no to a dessert.

Tim Ferriss: David and Nav, two incredible, incredible scientists and they were just appalled and disgusted because we were so well-behaved until we had two or three glasses of wine and decided, “You know what? Tonight’s going to be cheat night,” and the entire table was just piled with plates of dessert and I’m not ashamed, not ashamed —

Peter Attia: So I am thinking next year of changing it to three days a month, just as a way to mix things up. It’ll be a little less socially intrusive. The week of fasting becomes a little bit of a grind. I only do it when I’m away from my family and I always go Sunday to Saturday, so I do Saturday and last meal is always a Saturday and first meal is a Saturday. Whereas I was thinking, yeah, what if I just did like a Monday, Tuesday, Wednesday, the first Monday, Tuesday, Wednesday of every month or something like that. That would be an alternative way to do it.

Tim Ferriss: Yeah. I’ve done seven day and 10 day, but I’ve done more of the three day. I’ve always started on Thursday early dinner. That was the last meal because I could gut through. I wasn’t doing the — 

Peter Attia: So you prefer to be, see I like to be fasted during the week more than the weekends.

Tim Ferriss: I can get grumpy depending on the transition because generally I’m not doing the ketosis first, I’m not coming into it producing much in terms of ketones. So I’m going cold turkey water only, let’s call it 7:00 p.m. on a Thursday and then I can gut through Friday, especially if I schedule things such that I’m having mostly admin, like phone calls and so on. Nothing that requires any degree of delicacy or diplomacy. So I don’t leave scorched earth in my inbox that I need to unfuck for days afterwards. So usually it’s early and then I go water only and I’ll walk a lot on Friday. Basically just do a walk and talk with lots of water and a handful of electrolytes and so on.

Are you supplementing when you go water only? Are you going directly from a ketosis, ketogenic diet into water only and not supplementing?

Peter Attia: No. I’m supplementing with sodium, magnesium being the two main things.

Tim Ferriss: Are you supplementing with different types of magnesium or just a single type?

Peter Attia: Yeah, two different types. During the fast I use slow mag and I use L-Threonate in the evening, so SlowMag, I take two SlowMag in the morning, two SlowMag before bed along with two magnesium L-Threonate before bed.

Tim Ferriss: It’s the Mag team?

Peter Attia: Yes. Yeah.

Tim Ferriss: That’s good stuff.

Peter Attia: It’s really a fantastic product.

Tim Ferriss: Yeah. Yeah.

Peter Attia: All right. I’m glad I passed 10 different times on investing in the company.

Tim Ferriss: Those are the best investments.

Peter Attia: Well, it sounds — 

Tim Ferriss: When you’re like this, this like record-setting trout just kept throwing itself into the boat and I just tossed it out and then I was like, “Oh yeah, I’m on a fishing trip. Oh, that was dumb. Shouldn’t have done that.” What’s something else that you’ve changed your mind on?

Peter Attia: Okay. This one’s a little heavier. I think that the fate of one’s personality may not actually be set. I think I have historically believed that we are born with hardwired motherboards and our personalities are set in stone and there’s no changing them. And in particular, I think for me, you and I’ve talked about this a lot, I’ve never known a time of not being angry. I think I was probably just a pissed-off fetus is my — and I don’t think that’s actually true, but that’s been my belief template. And I don’t know, I think just a few years ago, maybe more than that, maybe 10 years ago, even 15 years ago, I remember having this discussion with my dad once. It was really a sad day because my wife and I, who had been barely married, we might have been married for like a couple of years and my parents were over.

I’m even too embarrassed to tell the story, but my wife and I had a fight, which was basically just me being a total piece of shit. In other words, it’s not even like there was any symmetry in this. It was just, I was 100 percent wrong and I dug my heels in and I was such a jerk. And you could tell my parents were just so sad for us. And I think sad for me at my miserable existence. And I remember my dad not saying anything, but his body language being like, dude, what? What are you doing? Why are you such an asshole? And so I preemptively struck at him, which was, look, I don’t even want to hear about it man. Just I’m not meant to be around other people.

You know, I just remember going like, launching into this tirade about how I am not really designed to be around other people. There’s just no two ways about it. I’m way too volatile. I’m way too angry. I’m way too all of these other things. And I think I’ve carried that belief system with me up until about a year ago, up until probably, yeah, up until about a year ago, maybe year and a half ago. And I now realize that that entire narrative is simply incorrect. It’s no more correct than saying I have two copies of an APOE E4 gene, which would be a genetic template that would make you much more likely to get Alzheimer’s disease.

But arguing that it’s a given that you’re going to get Alzheimer’s disease, that’s not the case. These are not deterministic genes. And similarly, I don’t think that these flaws in our personality are deterministic. And while there may be people who are more or less predisposed to be one way or the other, and then of course events in life can reinforce that and push you more into that. And then the response to that can reinforce that. So all of those three factors can drive you in a given way.

I know this sounds like a very glib example, but I really think that with enough work you can start to overcome these deficits. And I think that for me, I think I’m only 50 percent as angry as I was during my anger heyday. And so I don’t know, to me that’s amazing, because I now have this confidence that I’ve never had before, which is two years from now I might only be 50 percent of what I am today. And that would be 25 percent of what I was at the outset.

Tim Ferriss: The tracking of the fury half-life.

Peter Attia: Yes, exactly. I just think that that’s, that’s my personal example. But for someone who says I’m just not fill in the blank enough or I’m too fill in the blank. I do think a lot of us start to buy our narrative and we just start to believe the story. And for me that is by far the most hardwired story I’ve ever believed about myself. Then there are lots of stories I believe about myself, right? I mean, we all have our insecurities and I’m too this or I’m too that, or I’m not this enough or I’m not good enough, or blah, blah, blah, but this one was like, no, no, that one you don’t get to change. Like that’s eye color and there’s not even a contact lens you can put on it. It just is what it is.

Tim Ferriss: I’ve seen certainly, and we talk about a lot of this in the first episode of your podcast where you and I had a long, long conversation about many of these things. The Drive, we’ll link to it, but I don’t know if we talked about this particular perspective on what we might use deficits or weaknesses and that is finding a way to inspect them as coping mechanisms and protective mechanisms that served an incredibly important function at some point.

Peter Attia: That’s exactly right.

Tim Ferriss: So instead of refusing and rejecting those pieces of you maybe, feeling anger towards them, certainly which I’ve done plenty of, instead looking at how you might thank them for mitigating or preventing, even if it ended up being now counterproductive when overused, but at some point these were responses that protected you, right? If that were the assumption, how might you look at them differently? Could that possibly be true? And that’s been incredibly important for me and reconciling all different types of facets of myself that I’ve long held resentment and anger towards.

Peter Attia: Yeah, and if we were to really double click on this topic, that’s exactly the direction we’d go, which is, it starts with a little bit of self empathy and introspection and realization of, well let’s examine the why. This must have served some purpose at some point. This was an adaptation to something. Let’s acknowledge that. And in the words of Terrence Real, who I just recently interviewed for my podcast, it’s taking that adaptive child in you and thanking them, but just moving them to the back seat, making sure their hands aren’t actually on the steering wheel and saying, “Hey, thank you. Thank you for the help you gave me during this period, but I need you to just sit back there now and just chill out, man. Just look out the window. We’re just going to go on a drive. But the adult has to drive now.” Yeah.

Tim Ferriss: So this is a hard segue into stupid and absurd things, but let’s fucking force it.

Peter Attia: And what’s funny is looking at the stupid thing, I’ll just tell you what it is and you’ll see why it’s really funny! So the next stupid thing on my list is tearing phone books, but I will say it’s not out of rage.

Tim Ferriss: This is like a wine pairing. It works perfectly.

Peter Attia: When I was in college, a good friend of mine named Todd Remington, I’ll never forget this, it was his wife and my then-girlfriend were like best friends. So we were all four of us were at their place and he came home with a phone book, like a standard two, two and a half inch phone book. And he goes, do you think you can tear this? And in college I was really strong. I was like, probably not, but let me try.

And I just wailed on this thing and of course could not tear this phone book. And then he shredded it. Just ripped it in half. And I was like, Oh my God, how did you do that? And he immediately just told me, he’s like, “Look, it’s a technique.” And he explained the technique and I was like, “All right, well do you have another phone book?” He’s like, “No, that was our only one.” And I was like, “Are we going to get more?” And this was back in the day when like you had phone books. So I remember this, we got into his land Rover or whatever. No he had, I don’t know, some Toyota like — 

Tim Ferriss: 4Runner.

Peter Attia: — 4Runner. That was it. Yeah. And I still remember, in a silver 4Runner, and we drove to the mall, which was like 20 minutes away and we went into the phone store because they had phone stores inside of malls. This is like pre-cell phone and they had a wall of phone books, hundreds of them. And I don’t know why. It was just such an obnoxious thing of me to do. I just started grabbing all the phone books and the woman comes up and she goes —

Tim Ferriss: Not a word.

Peter Attia: Nothing just totally, and the woman comes up and goes, “What are you doing?” And I was like, “Oh, I work at a camp for kids, and we do a lot of paper mache, and the phone books are the best for paper mache.” And she was almost apologetic. She’s like, “Oh, oh, okay.” I think I mumbled like it was a camp for kids that had like less than a week to live or some stupid thing — 

Tim Ferriss: Terrible, terrible.

Peter Attia: So we leave the store with as many phone books as two guys can carry, go back to his house. And I practice that night until my hands bled and I could tear phone books. And by the end of that night I was very good at it. And then it became fully pathologic as an addiction, so I could not see a phone book and not tear it.

Tim Ferriss: Like the Cookie Monster.

Peter Attia: That is exactly right, it was like Cookie Monster. So I remember in college I rode my bike everywhere and this was back in the era of phone booths and phone books. And so anytime I rode past, even if I was late for class, if I saw a phone booth, I stopped, laid my bike down, went into the phone booth, grabbed the phone book, tore it, got back on my bike, rode to class. So I just left in my wake torn phone books everywhere. So fast forward a couple of years I’m applying to medical school. I put together a spreadsheet of all the factors that go into the decision of where do you want to go.

What kind of research opportunities, what’s their ranking in the US News and World Report? What’s their success in getting you into the residency of your choice? What type of this blah, blah, blah, blah, blah, blah. What is the size of the phone book in that city was one of the columns in the spreadsheet. It was absolutely a criteria.

Tim Ferriss: So what was the sweet spot? Was it the bigger the better? Was it? It’s not the size, it’s how you use it?

Peter Attia: At some point, if your technique is impeccable and you’re strong enough and it really just comes down to grip strength. It’s not like the strength of your biceps or something like that. It’s basically how strong are your hands and how well do you know the technique. You become limited by hand size. So for example, I could never tear the Toronto phone book.

It was simply too big. I couldn’t get my hands around it. Now at some point enough strength will overcome it. I’m sure if I were stronger I could have done it. So the sweet spot for me was about three inches. And so I wanted to go someplace where the phone book was two and a half to three inches. All things equal.

Tim Ferriss: You can get in some good working sets.

Peter Attia: Yes, exactly. And so now I go through medical school tearing every phone book in sight. I just can’t stop and I’ll conclude this stupid story by saying how it has a funny ending or not ending, but a funny point in the middle. And I don’t actually remember this, I only remember this because she reminded me of it, but on the very, very, very first date with my wife, which was in Baltimore, which we met at Hopkins, we’re downtown Baltimore — not in the part where you get killed, but in a nicer part of Baltimore.

And it was that time of the month or year or whatever when the phone books were being distributed. And so we went to this dinner called the Sobo Cafe. I still remember. And as we walked out there was a stack of five phone books on the doorstep of an apartment building. And I said to her like a little child. I was like, “Do you want to see me tear a phonebook?” And she was like, “No.” And I was like, “Let me show you.” And then of course — 

Tim Ferriss: Undeterred.

Peter Attia: So I was like, “Here, try to tear it!” Like my 100-pound wife is going to tear a phone book. And she’s like, “I can’t tear it.” I was like, “Watch!” I tore it. She’s like, “Why did you tear that phone book?” I was like, “Do you want to see me do another one?” She’s like, “Definitely not.” I was like, “I’ll show you. Let me show you the techniques.” So then I pick up the second one, I tear it. She’s like, “Okay, definitely don’t do that again.” Of course I tore all five of them. That is such a dick move. That’s five people that didn’t get their phone book and I always left the halves there.

Tim Ferriss: Just in case they want to reassemble it.

Peter Attia: It’s not like you can’t find the number in it, but now it’s just a bigger mess and yeah, she just reminded me of that I don’t know, five years ago. She’s like, “Do you remember that night? You tore all those phone books.” So I don’t know. I don’t know what it was about it. I will say this, I’m nowhere near as good at it as I used to be. I remember trying to do a couple of phone books a few months ago and it’s definitely a technique you have to stay up to speed on. The first one I fumbled on a little bit and the second one I got after it. But yeah.

Tim Ferriss: I would imagine that you might want to do a preemptive funeral for phone books. At some point you will have no more phone books. I mean, there’s the possibility you’ll have to go to a museum of phone books to even get ahold of something that you might desecrate with ripping.

Peter Attia: Yeah. I think that’s probably why I’m not as good at it anymore. I just don’t get the reps.

Tim Ferriss: All right. It sounds like you’re still pretty excited about phone books, but we’ll keep that in the absurd bucket.

Peter Attia: Yes. I took this section to be stupid things I do. Not stupid things I did.

Tim Ferriss: Oh, nice. That’s even better. Oh yeah. No, I like present tense. Excited about. What’s next up on excited about?

Peter Attia: So this is something that you deserve quite a bit of credit for, but just archery hunting and the consumption of wild game. And again, it started out totally benign as, “Oh, maybe I’ll just get a bow.” Tim has told me about why he enjoys this and I’ve got a bit of a sense of — and just for the listeners, I guess the story is, it would have been the summer of 2016, you were getting ready to go out on a hunting trip. The irony of it of course was it was with a guy named Jonathan Hart who I would get to know years later.

Tim Ferriss: Yeah. Founder of a great brand called Sitka. Yeah. Excellent. Excellent gear. Yep.

Peter Attia: Unbelievable gear. And after watching you go through that journey of training for and going on the hunt, I was like, “I might get a bow. It just might be one of those things I want to do every, couple times a month.”

Tim Ferriss: Just to pause for a second. So I also have come to, I think better understand the perfect — or more perfect than I used to understand — cocktail of characteristics that make something more likely to be your crack cocaine of activities.

Peter Attia: Tell me what you think.

Tim Ferriss: In the preparation for that it was very methodical, very meticulous. You have gear to tinker with, right? It brings in some degree of mathematics and physics, which you have background in. So there’s more to it, but continue.

Peter Attia: Yeah, so in early 2017 I call up the local bow shop, Performance Archery in San Diego, just get real lucky and the guy that happens to answer the phone, J.R., turns out to be a complete obsessive. I mean it turns out everyone that works there is totally obsessive, but J.R. might even take it to another level just in terms of his technique obsession. And the rest is history, as they say. And it’s now at the point where, in some ways, my life revolves around this thing. If you come to our house, I mean you haven’t been in a while, you need to see what it looks like now.

Tim Ferriss: Yeah, I haven’t seen the new range.

Peter Attia: It is out of control. It’s like, you know those huge block targets now?

Tim Ferriss: Yes.

Peter Attia: The five feet by five feet block targets. I’ve got like eight of those, every animal you can imagine throughout the range. And yeah, every single day my morning routine involves at least one round of 300. So 300 is the scoring system you use on the paper target when you either shoot at the three spot or the five spot. So I’d like to get 90 shots out of the way first part of the day at the target and then do the longer range shooting, the 3D target shooting. And I will say this, a big part of this is this has been an amazing tool, tying it back to part of the training, a new set of emotional skills. There was a day when if I didn’t shoot well that was the end of the day. Everything went off the rails. And I’ve talked about this, I think once even on a post, an Instagram post, I was kind of opening up about this, which was even as recently as a year ago.

I remember there was a day when there was something wrong with my bow that I didn’t realize at the time, but I ended up lodging three straight arrows into the fence. So I’m taking long range shots, but I missed something in my bow and one, two, three arrows into the fence and you can’t recover an arrow once it’s in the fence. So that’s three arrows I just flushed down the toilet and I was so pissed that when I took each of them out of the fence, because you have to snap them to pull them out of the fence. I then proceeded to snap each one over my thigh. Now these are 450 to 500 grain carbon fiber arrows. I was welted for a week, which if you — 

Tim Ferriss: You basically gave yourself a Thai kickboxing leg kick with each one of those.

Peter Attia: Yeah. So, when you think about the complete and utter stupidity of that type of behavior, I’ve now realized archery is always going to be an amazing teacher because either you go up there and you just have this amazing day where you’re in this flow state and everything goes well and it feels amazing or it’s some variation of not going that way, but you get to this skill of distancing yourself from the narrative that is, “Dude, you suck. You suck. How can you be so bad at this?” And all of these awful, stupid thoughts that spiral out of control. So that’s a part of it.

And then of course the other thing is then once I finally took these skills into the field and began to hunt and began to experience this cycle of what is it like to go into an area where you have an animal that is a pest, that needs some population control in the area that we hunt? It’s so much the case that the government is basically killing these animals and just leaving them for dead or burying them and you instead get to go and try to use your skill to do this and then harvest the animal and then feed your family and feed yourself. The whole thing is such an incredible experience that has changed many things about the way I look at food. Like it certainly reduced my appetite for consuming food that I haven’t had some relationship with and I think my aspiration is by next year, meaning by 2021 to only eat food that I’ve killed. I think I’ll be able to get there by next year.

Tim Ferriss: Yeah, there’s a lot to discuss there. It’s A, making me want to get back into archery. I do have my gear and only recently reconnected or I should say connected with two guys who train here in Austin, which I’m excited about. Not for hunts here, but at higher elevation and don’t hunt very often. In part because it’s been mostly larger game, so you’ve got a lot of meat afterwards to keep you busy. Oh, and I remember you were on Joe Rogan’s show and the name of the bird that I shot just for clarity was a grouse. Mountain chicken. It’s like the chewiest, fastest running mountain chicken you can imagine. So that’s what that was.

Peter Attia: It was an amazing shot.

Tim Ferriss: I was happy with that. I was very happy with that. Yeah, it was a grouse at like 30 yards with a bow. I was very happy with that. But the bow or I should say archery practice also is a really good audit in my experience. Like if your nervous system, if you feel recovered, but your nervous system is not where it should be, your body really tells you with archery, at least in my case. It’s a very effective and very fast assessment tool.

Peter Attia: I agree. I think it’s an emotional audit as well. John Dudley, who is probably one of the greatest influences on archery for me, if people are interested in archery and don’t know who John Dudley is, you just need to hit pause on this one podcast now and go over to John Dudley’s podcast called Nock On. And this is a guy who’s a world-class archer who also has the skill of being an amazing teacher. So a lot of people can be world class, but they don’t know how to explain to schmucks like us, like how they actually are doing what they’re doing. But John is that really rare intersection of someone who is exceptional but really knows how to break archery down.

And his teaching is, I mean one of the greatest lessons I learned from him, which is obvious, but it’s really good to hear it from someone so good is, you have no influence over the arrows that are not in your quiver. So every time you take that shot, it doesn’t matter how bad it is, you can’t do anything about it. And simply worrying about it increases the probability that that arrow that’s still in your quiver is going to be a bad shot.

Tim Ferriss: That’s a good metaphor. What type of gear do you use currently? And why?

Peter Attia: Yeah, so currently I’m using the Hoyt RX-3 bow, which I absolutely love. It sounds so stupid and my wife laughs at me when I say this and I’m sort of joking, but not really. I love it so much. It’s the only inanimate object I’ve ever wanted to sleep with in my bed. I just, I love everything about it. I love the way it looks and the way it feels. I mean, compound bows as you know, are just ridiculous pieces of engineering. Yeah. It’s just hard to believe that they’ve figured out a way to make something so efficient. I only shoot with a back tension release.

Tim Ferriss: What type is that?

Peter Attia: I use John Dudley’s release called the Nock 2 It and the Silverback. So he has a pure back tension release called the Silverback and then the Nock 2 It, it has a thumb trigger on it, but you still do it with back tension. So when your thumb is on it and the rhomboid contracts, that’s what actually pulls the thing back. But technically you could cheat with the Nock 2 It, you can’t with the Silverback. The Silverback is a pure back tension release.

Tim Ferriss: Could you explain the significance of back tension? And what that is? If you could paint a picture for people who are imagining archery.

Peter Attia: So if you picture, let’s say you’re right eye dominant, that would mean your left arm is holding the bow out and your right arm is pulling the string back. Now these compound bows are very hard to pull back. In the olden days, you used to actually pull compound bows with your fingers and you would release off your finger. Today we have a release that clips onto a little loop on a string called the D loop, and you’re pulling on that release. But whether you’re doing that or just pulling on a string, you still need the release to be a surprise. So a surprise release or a surprise shot is an essential part archery because it combats the sort of need of the motor system of your CNS and motor system to have this trigger anxiety or trigger panic while looking at the target. So if you’re looking at the target and you pull the trigger, you’re going to have a less accurate shot than if you’re following the perfect biomechanics and the shot releases without your knowledge. And so the way to do that is — 

Tim Ferriss: Don’t you need to get to a certain equilibrium with your focus before said surprise that you — 

Peter Attia: Absolutely, yes. So when you think about looking out — so what are you doing with a compound bow? You have two holes. You have the site, which is one hole, and you have the peep, which is another hole. So those have to be aligned.

Tim Ferriss: And for those who haven’t used compound bows, the site is going to be, if you imagine your left arm straight down in front of you, the site is going to be not that dissimilar from say the top, the iron sites on a handgun or something like that. You have a site down by your hand and then you have another hole that is actually on the string itself and you’re lining those two up.

Peter Attia: That’s right. So you have to get those two things lined up. In the site there’s a level, like the thing you’d hang a picture with or something with a little bubble. So the first thing you’re doing is you’re getting rear sight, front sight acquisition. Then you have to get the bubble level and then you have to get the pin where you want it to be. Now I use a pin that comes in the side because I have multiple pins in the bow. But if you have a pin at the bottom of the single pin, it’s the same idea. So you’ve now got rear sight, front sight acquisition, bubble level, pin on target, and then the target is still going to be moving. That’s okay. You have to trust the process. If all those other things are fine and that site, that pin is moving gently around your target, that’s okay. What you don’t want to do is try to time that and punch the trigger while it’s there. So instead that’s where you’re contracting the rhomboid and being surprised by when the tension is actually achieved in the trigger.

Tim Ferriss: Yeah, true with a lot of, as far as I can tell, a firearm instruction also.

Peter Attia: Yeah, I’ve never fired a gun in my life. It sounds odd I suppose, but anyone I’ve talked to who’s a marksman, they’ll say the same thing. There’s still a surprise release on the trigger.

Tim Ferriss: So much to talk about. All right, archery. I have seen your playground once, but it sounds like it’s expanded. The hamster cage has more toys in it now, sounds like.

Peter Attia: Yeah. And I’m about to order the monster elk.

Tim Ferriss: Peter’s menagerie. Animals of death. The animated pet cemetery in the back of your house. Changed your mind on, what else have you changed your mind on?

Peter Attia: Well, this in some ways builds off the last one a little bit, but it’s basically this idea that childhood experiences can matter in ways that, after the fact, seem irrelevant.

Tim Ferriss: So that’s not the belief that you have reversed. That’s the current.

Peter Attia: Yes, that’s correct. The current belief is, yeah, so I’ll rephrase it. I used to believe that traumatic events in your childhood probably weren’t that relevant or could be net positives if they — this is effectively like a parallel to the first thing to the previous one we talked about, about personality stuff. I think what I’ve come to realize through extensive interaction with experts in this space, my own experience, the experience now of many people that I know is, if a child perceives helplessness, even as an adult, if you look back and think, “Eh, that wasn’t so helpless,” you have to be thoughtful about what the implications and ramifications of that are going forward.

For example, let’s take an extreme example. If a child loses a parent when they’re young, you might say, “Well look, they have another parent. That other parent is a loving parent. Everything is going to be fine,” but there’s an enormous amount of chaos that’s inserted into that person’s life. And if a child perceives that as helplessness, that can really shape the subsequent years of their life, that can shape aspects of their personality that I just don’t think I really understood and appreciated before. And I’ve seen this now with a number of my patients, for example, using that example. Patients who lost parents when they were very young, seven years old, eight years old, 12 years old. Suddenly and/or tragically, or not suddenly or tragically. You could have someone who’s suffering for three years with cancer and it’s not sudden, but it’s still to a child, they perceive things differently. An extension of that, which comes back to this whole thing around anger. And this was part of my motivation to begin to make sure I wasn’t so angry was I almost never got angry at my kids. But my kids saw me angry.

So the last time I got really, really pissed in front of my kids was a year ago, and I remember this very well. We were actually driving to a funeral of the mother of one of my daughter’s best friends. So this is a young woman, woman who’s in her forties who dies of cancer and we’re going to the funeral. It was exactly a year ago. So it’s not a happy day. And so it’s me and my wife and my daughter going to the funeral and I’m driving and traffic is moving along at a slow pace and there’s a merging lane that’s coming on and there’s this woman who’s not paying even a modicum of attention to what’s going on. She’s on her phone or something and then at the last minute she just goes, whoa, accelerates, jumps in front of us. I almost hit her and I mean normally that would be annoying, but on that day I went ballistic. She didn’t even hear me. She’s in another car, but the torrent of just profanities and what I wanted to do to her and say to her and blah, blah, blah, blah, blah, was unbelievable. Heightened, presumably, of the fact that I was just in this awful mood about all this other stuff. Whatever.

I never for a moment would have realized that could have an effect on my daughter. It’s like, I’m not yelling at her. I’m not yelling at my wife. I’m yelling at some random stranger in front of us, but I realized that kids internalize that stuff different. My daughter’s not a baby, but she’s still a child. They internalize that type of stuff as it’s still hitting them. I don’t know how to think of it. There’s still shrapnel that is hitting them in a way it wouldn’t hit an adult. And so you take an extreme that’s very minor, you take an example that’s very minor like that one versus something that’s very major like the funeral we were going to, which is for her friend’s mom.

I don’t think we are paying enough attention to how these things that kids experience can shape their personality and to be clear like these are two edged swords. There are some good things that can come from hard experiences. I’m not suggesting everything is negative, but you don’t have to throw the baby out with the bath water. You can accept some of the positives that come from these things without ignoring the things that need to be mended or repaired. So I think that broad topic is something that I have really been much more attentive to both in myself and in my patients and in understanding their lives and their emotional health as it pertains to the events of their childhood.

Tim Ferriss: Speaking from my firsthand interactions with you, we talk quite a bit or just text stupid jokes to each other, at least that with fair frequency. You are much less anger-ridden than you have been historically, which is really nice to see and it’s something that I’ve battled with a lot of myself also, quite possibly for similar reasons or some similar reasons, but what resources or tools, if any, I don’t know if there are any books or anything else that you would recommend or simply mention as having been valuable for defusing the default anger response or helping you to revisit the story of that being an alterable aspect of your personality?

Peter Attia: I think there have been a lot of things. There’s no one thing, which isn’t to say that for others, one thing couldn’t do the trick. I think the good news is if somebody listening to this and they’re also thinking to themselves, “Man, I just wish I was a little less angry too.” I think the good news is the probability that you are walking around with as much anger as me is hopefully low. You’re probably starting from a better place and therefore maybe your anger is less recalcitrant to change. There were many things.

I’ll start with one. Meditation has made a big difference, not by itself. Meditation simply gives a gap. That’s the only thing meditation does is it creates a pause between the stimulus and the response and that gap used to never exist. That gap, I didn’t even know it was a gap. It was a potential space that I didn’t realize had the potential to be a space, which meant stimulus, woman cuts you off while you’re on the way to worst funeral You could be imagining going to, blowing up. That’s happening in microseconds. Not milliseconds. Well the difference is today, that still happens every day. Some stupid thing will happen that would’ve normally fired me off. The difference is now I have seconds to inspect that and look at the template of beliefs that are feeding into that and examine the why, which is what is anger? So that’s that. The first thing is using a practice of the past and a meditation to create a tool in the mind to slow time down. Then the second one is —

Tim Ferriss: And is that, sorry to jump in, but just for specifics, I know that you and I both used Sam’s Waking Up. Do you now meditate without that? What does the practice look like?

Peter Attia: No, I use either Sam’s or Dan Harris’s. I go back and forth between them. So sometimes I’ll do like a month on one and not see the other one and vice versa. I go back and forth with no rhyme or reason.

Tim Ferriss: The Harris twins. Unrelated.

Peter Attia: Yes, exactly. The brothers Harris, no relation. So, yes. I can think of a million analogies. It’s like imagine being a race car driver and you get to see time travel half as fast as the other drivers. Well you’re going to be a much better driver. You see the road coming at you at half the speed.

The second thing is just work through really helpful therapy has been actually examining what anger stems from. So I think the first time I was ever, I want to say forced to or suggested to play the game of emotional check-in, I didn’t have a vocabulary. So the question was, how do you feel right now? Pissed off. Okay, say more. How do you feel? Fucking pissed off? How do you feel? So fucking pissed off that if you fucking ask me again, I’m going to fucking kill you. That was the only response I had. What I didn’t have at the time was I didn’t even have a vocabulary to understand, I’m hurt, I’m sad. I feel helpless. I don’t feel in control. I had to learn a new vocabulary and start to learn what those other things looked like so that I could in that gap of time start to say, “Oh, you’re feeling X, but you have such a beautiful default wide lane highway that turns X into anger. And oh, by the way, yours turns Y into anger and yours turns Z into anger too. That’s Peter’s thing.” Other people might have depression or sadness or anxiety as these other well-worn paths that come out of these various converging stimuli. So learning how to recognize what was understanding that has made a big difference.

Another thing has just been traditional insight-related therapy. So Esther Perel, who I actually met through you many years ago, who is an incredibly important part of my life today. I’m trying to think. Oh, I know what it was.

Tim Ferriss: For every Jocko you get one Esther Perel. I’ll take it.

Peter Attia: So I’ll tell you the last time I actually lost my shit. It wasn’t a year ago. It was a year ago was that funeral. It was more recently than that. It was when one of our chickens got killed. And so I’m up actually shooting, doing my archery and I hear my daughter scream like something’s wrong. And I run down and she’s crying and I see one of our chickens is mangled into a million pieces. And of course I immediately figured out what’s going on. And we had just lost one like, I don’t know, a month earlier. I thought I had reinforced the coop as much as possible, but clearly I hadn’t done a good enough job. And I just went off on a tirade. And again, I’m embarrassed to even say all the things I said, because it’s so stupid. I’m basically yelling at whatever animal that is no longer there that killed our chicken about what I’m going to do to it.

Again, we can laugh at it. It’s so ridiculous. What Esther was able to point out was, let’s deconstruct that whole situation. So first of all, why are you angry? Well, if I’m going to be brutally honest about it, I’m angry because I feel inadequate. I failed. My job is to protect my family and my chickens are now a part of my family. I failed at protecting these chickens. It can’t be that I’m actually angry at the bobcat for being a bobcat. Marcus Aurelius once said something along the lines of, it’s like being angry at a fig for making fig juice or something like that. Or like a fig tree for growing figs or something.

So no, there’s no way I’m pissed at the actual bobcat who killed the chicken, that’s like the carbon cycle. That’s the way it works. I’m pissed at myself. I have failed to protect my family, blah, blah, blah, all these other things. But the point is, in that moment I missed an opportunity to console my daughter. I was so consumed with my own rage and rage as you can probably relate to and many people who get angry can relate to, it’s a very numbing transiently numbing thing. Lots of dopamine gets secreted in that outburst that actually makes you feel a bit better. Now that doesn’t last long. It’s a very hollow, I think there’s a saying about the, it’s like a honey with a poison tip or something like that. It’s a very short lived, transient benefit that comes with a long tail of misery.

But I lost an opportunity, which was my daughter’s actually very upset about this. Not only do our chickens give us eggs, but the kids love them. They play with them every day. They all have names, we know everything about every one of those chickens and their personalities. It’s no different than her losing her cat or her dog. And instead of consoling her, I’m wrapped up in my own nonsense. So sometimes you actually have to be confronted with that type of brutal truth. And again, if you go back to the first thing, which is you now have a gap, the next time, a couple months later something came up. It wasn’t related to the chicken, but it was something where I think the Peter of old would have gone right down the default pathway of just raging. I had that breathing room to notice the feelings of another person and realize, wait a minute. The much more important thing to do here is make sure that person is okay and not go down your own stupid rabbit hole.

Another tool that I think has been very important here, Ryan Holiday recently put out, and I’m sure it’s still available, a whole 10-day or 11-day course on anger. Ryan writes about anger a lot and I’ve talked with him about this actually in my interview of him very recently, which probably by the time this is out will not even be out yet, but those types of exercises are helpful. Again, it comes down to this idea that once you accept that this is not something you are hardwired to, like your height or your shoe size, then you can start to change it, you just have to start working at it. So there are a number of other tools as well. I think a lot of the sort of David Foster Wallace relational reframing stuff also has been just incredibly helpful.

Tim Ferriss: So there is an audio recording of his commencement speech, This is Water, that you listen to on a regular basis?

Peter Attia: Yeah, to this day I still listen to it at least once a month, usually more than that.

Tim Ferriss: So people can can find that in the show notes. I’ll put that in the show notes as well. For you at this point in time, what are the characteristics of a therapist who is good for Peter? I’m curious because I have historically, and I’ve largely gotten over this, but had a skeptical view of most therapists and you come from a math background, you come from a hard science background and also the experience of a surgeon, where a pass fail or an A+ versus a C- is, I would imagine, pretty tangible and easy to assess. If you’re doing reconstructive surgery and the person’s nose is on the side of their head, well you don’t fucking pass go, do not collect the money. And with therapy, it is a softer, in some respects or I wouldn’t even say softer, it’s a harder field to assess. At least I have viewed it that way. How do you wrap your head around that? How do you think about it?

Peter Attia: That’s a great question and I don’t have an answer. I have my answer, but I don’t know that that’s the answer.

Tim Ferriss: I’m interested in your answer.

Peter Attia: It almost assuredly is not. In the end, two things have to be firing. There has to be the connection and chemistry between you and the therapist or I’ll just talk about me. I have to be able to connect with that person and for me that means that their insights have to be such that I exit almost every session thinking, “Wow, I see something I didn’t see before.” I love that. So that’s the short term tangible, that insight, that’s surprising. It gets to the point where first of all, I journal in the sessions a lot and I sometimes even record the sessions. That’s how powerful I find some of these insights to be, where I can’t even capture them all if I’m there without those tools.

But the second thing that matters to me is the results. In the end, none of this stuff matters if it’s not reducing your suffering. I use that term very deliberately instead of, if you’re not happier. I don’t exactly know what happiness means, but I do know what suffering means. And I do know what it’s like to suffer less. And anything that helps me suffer less, which is quite easy for me to assess, is a good thing. And so if I feel that there’s this connection, chemistry, and constellation of insights that are constantly evolving from the discussions and it’s translating to a phenotypic benefit, that’s resulting — 

Tim Ferriss: That is the most fucking Peter way to describe this ever. Phenotypic benefit. Don’t worry, folks. I don’t get it either. Fuck, Jesus. All right.

Peter Attia: I’m going to have to let you edit my book before I catch any of those things in there. Then those are the only two things that matter. So in other words, there’s other little things like, I think for me, the therapists that are really valuable are also the ones that frankly just don’t have a hard time telling you when you’re wrong. They don’t have a hard time telling you you’re totally full of shit and deluded or that you’re being a dick. I have three main therapists, which sounds, I know ridiculous, but I think when you’re trying to solve some of my issues —

Tim Ferriss: It’s like a pit crew.

Peter Attia: Yeah, exactly. Esther and Terry and Laurie and I have had some really brutal sessions with Laurie and I don’t know why it’s worked out that way. They all know each other, by the way, very well. So that’s another thing. It’s not a counterproductive experience because the three of them know each other and they all know they’re chipping away at different pieces of things. But I’ve had some very difficult interactions with her where she has just said to me like, “You are being a spoiled little baby. Do you see how you’re behaving right now?” And I think the fact that she can do that matters a lot. I think there are a lot of people that would give me a pass on stuff because it’s easier to, it’s hard to stand up to someone.

Tim Ferriss: Yeah, I think you need or need’s a strong word, but I certainly, when interacting with specialists of almost any type, I prefer people who can fire me very easily. Do you know what I mean? Because then it makes it a lot easier for them if they’re in demand or are completely, utterly concerned with how many billable hours they’re racking up that they can be like, “You know, Peter, you’re making this really fucking difficult for both of us. I just want to like pause for a second to allow you to like wallow in how fucking unnecessarily difficult you’re making this, and it’s like, “Oh, okay. Oh yeah,” which yeah, I think I’m probably also the problem child oftentimes, so we were on — 

Peter Attia: I think we’re now into stupid things again.

Tim Ferriss: All right, let’s do it. Stupid things.

Peter Attia: To this day I still play a game called Forks and Knives.

Tim Ferriss: Forks and Knives?

Peter Attia: Forks and Knives is the name of the game, so I have an awesome system with my wife, which is, she likes to put stuff in the dishwasher and hates to take it out. I hate putting stuff in the dishwasher and I love taking it out. I just, I don’t like touching dirty stuff. I really like clean stuff and I don’t know why she doesn’t like taking it out because that seems more enjoyable but anyway, and as a kid, this game started when I was a kid. My mom says, like, I was the best at chores. Like my brother and sister apparently didn’t like doing chores as much as I did, but I loved chores.

I was like her little helper, so whatever she said to do, I couldn’t wait to do. One of my chores was doing the dishwasher and I loved it. This started when I was probably like about eight and I remember she used to always say, “Peter, can you put away the forks and the knives?” It really kind of got to me because I was like, “Why don’t you also include the spoons in that discussion? It’s not just forks and knives, it’s forks and knives and spoons,” and she would be like, acknowledged that I said that, but the next day she’d forget and she’d be like, “Can you please put away the forks and the knives?” I was like, “I’m going to just start keeping track,” and so I played this game where I would count the forks and the knives and the spoons and the game is the spoons would win anytime there were more spoons than forks and knives. Now anyone who’s played this game, and I’m guessing the answer is nobody — 

Tim Ferriss: Wait a second, the number in the dishwasher?

Peter Attia: Yes.

Tim Ferriss: That you’re removing?

Peter Attia: Yes.

Tim Ferriss: Okay. I see.

Peter Attia: I basically, every time I got to do this, it turned into a game of who’s going to win, the forks and the knives or the spoons?

Tim Ferriss: Which was a counting — 

Peter Attia: That’s just a counting game, but I was always rooting for the spoons because they’re the underdog, because the probability of the spoons winning is very low. You generally have way more forks and knives combined than spoons. Over the years, the game evolved and I started to allow other things to be proxies for spoons. If there was like a spatula or a carrot peeler, that would get to go in the spoon category just to sort of level the playing field a little bit.

Tim Ferriss: Handicap, man.

Peter Attia: Yeah, you had to handicap this thing somewhat, but the game started almost 40 years ago and to this day, I mean, just two days ago I played forks and knives versus spoons and I love it. I love — and it’s at the point now where I don’t want anybody else to put that stuff away. Let’s say like Jill is putting stuff away. I’m like, “No, no, no. I want to get the forks and knives. I got to get those guys.” Let me tell you, spoons don’t win much. It’s a sad state of affairs if you’re a spoons fan. But if they win once every three months, like it is freaking awesome. It just feels so good when the spoons win.

Tim Ferriss: What is the furthest you’ve stretched the label of spoon? Like what, can you think of anything that where — 

Peter Attia: There was a big inquiry came into the rule committee about 20 years ago where I thought if I could start including cups as spoons because you could see how you could create sort of a post hoc analysis that would suggest that, well, a cup sort of holds things like a spoon holds things. You could drink soup out of a cup just as you could use a spoon, but I decided that was a very slippery slope and I didn’t want to take the game down that road. I thought that was going to really tarnish the sport that I loved so much. I decided I would rather lose 90 times out of 91 times, but know that that one time I won, it was the sweetest victory.

Tim Ferriss: This is going to seem like a complete non-sequitur, but that as you were saying this on the rules committee, I’m thinking about doping in sports and then I started thinking about this conversation we had long ago about xenon gas. I don’t know if you remember this. Did you end up ever looking more closely at xenon gas?

Peter Attia: Yeah, it’s so funny you remember that. I actually called, what’s the name of the company? Airgas, and I think it’s called Praxair like the two — 

Tim Ferriss: Yeah, Praxair.

Peter Attia: Yeah, and basically, the deal died when I just couldn’t get a reasonable supply of xenon gas. Reasonable meaning like enough for me to use. I basically had to buy enough to provide xenon gas for the entire universe.

Tim Ferriss: The speculation was that, or maybe it wasn’t speculation, maybe it had been confirmed. I can’t remember because I don’t know how you track such a thing, but, or maybe you just have to catch them inhaling, but it was being used by endurance athletes at the Sochi Olympics.

Peter Attia: Yes. It was basically an illegal PED, and this was probably six years ago and at the time I was still competing in cycling and I was like, well, like I was comfortable with the safety profile. It was legal and it was enhancing performance. I was like, “I want xenon gas. I want to take a big bong of xenon gas every day before I go and work out.”

Tim Ferriss: Are there any other currently legal performance enhancing drugs that you think the cat and mouse game of dopers and anti-doping committees have not yet or I should say the, I’m not sure which is the cat and which is the mouse. I guess the cat is the IOC and so on has not caught up to? What are things that are simply difficult to test for?

Peter Attia: Well the latter, definitely growth hormone fits into that category. Growth hormone is clearly banned by WADA USADA and every entity out there, but it’s very difficult to check for because it’s a human recombinant equivalent and unlike something like testosterone, where you can give somebody testosterone but you can — even though it’s bio equivalent, you can — if you’re getting it from the outside of your body, other things change inside your body that become a signature of it. Whereas, that’s not quite as easy to do with growth hormone.

Tim Ferriss: No. Would a signature in this case be, would it be looking at a ratio of what is it, testosterone? Epitestosterone?

Peter Attia: Epitestosterone, yeah, and if you take enough of it obviously, you’d see inhibition of luteinizing hormone, follicle stimulating hormone, things like that so no, I’m not close enough to it at all. I just don’t — it’s been a long time. I mean, one thing that I did notice just through some sort of personal interactions I’ve had with professional athletes who are also interested in sort of mind altering drugs is psilocybin is not banned by WADA and MDMA is. I sort of find that hilarious because I don’t think either of those things have a performance enhancing like — I mean MDMA would be a performance — 

Tim Ferriss: Great for Greco-Roman wrestling.

Peter Attia: Yeah, it’s like I can’t think of one sport that gets better with MDMA, so I was sort of amazed to see that on the WADA list.

Tim Ferriss: If you went very high dose, what is it? Methylenedioxy?

Peter Attia: I mean, yeah, I mean it’s some, technically it’s a methamphetamine, but I don’t know.

Tim Ferriss: What is the term for the eye movements that are so often characteristic of higher dose MDMA use? It’s like astigmia? I can’t remember the term, but it would definitely not be good for something like archery when the eyes effectively do this back and forth kind of ratcheting movement. I can’t remember the term. Somebody I’m sure will point it out when they hear this. Yeah, psilocybin’s an interesting one. That we could certainly delve into just from a — it’s like many things, better get the dose right. If you’re thinking of using it as a performance enhancing or pain reducing — 

Peter Attia: In truth, I have talked to people who have said at very low doses, psilocybin has actually enhanced their physical performance, so who knows? Maybe there was something to that.

Tim Ferriss: I’ve heard the same from endurance athletes using a relatively, or not relatively, low doses of LSD, like 10 or 15 micrograms or maybe even 10 to like 25.

Peter Attia: Wow. It’s hard to believe. It seems so imperceptible, like, that seems like such a small dose.

Tim Ferriss: It does indeed. Yeah. Well, I mean, this upcoming weekend, by the time this comes out, it will have passed, there’s the psychedelic science event here in Austin with MAPS and one of the sessions is specifically focused on micro-dosing, which this would fall under the umbrella of at 10 to 15 micrograms.

Peter Attia: Mm-hmm (affirmative).

Tim Ferriss: All right. Where are we, excited?

Peter Attia: We’re back to excited, yeah.

Tim Ferriss: All right. Yeah, we’ll do one or two more. Let’s go with excited.

Peter Attia: Next thing I’m pretty excited about is just driving, just sort of getting deeper and deeper into the craft of learning how to drive a race car and sort of just training both in the simulator and actually on a race track with a race car. Again, I think part of it is I just I love mechanical things. I love cars, I love driving them fast and there’s no better place to do that than on a race track. Also, part of it is it’s another one of these audits. Like archery, it is not a sport that gets better the more pissed you are.

It is not a sport that gets better the harder you squeeze. It’s also a sport where, let’s say you miss an apex on a turn. If you think about that or dwell on it anymore, it only increases the likelihood you’re going to miss the apex on the next turn or miss your breakpoint or miss your turn in point or do something wrong. It’s one of these things that teaches you a skill that I just think is good for life, which is you don’t want to not know that you made a mistake because then you run the risk of making that mistake again, but you can’t beat yourself up for making the mistakes. You have to have a relatively short half life for torturing yourself. Otherwise, you will spiral out of control and it’s really amazing. I just happen to be very lucky to have a great coach, a guy by the name of Thomas Merrill in driving.

Peter Attia: I don’t know, he’s so good at spotting when my mistakes start and it’s never really the case that when I screw something up at turn seven where I went off track — 

Tim Ferriss: That was the first screw up.

Peter Attia: Yeah, not even close. He’s like, “Actually, look at what you did at turn five and then look at how that fed into turn six and by the time you got to seven it was,” he said, “Look, the only way you are not going to crash at seven is if you had slowed down enough to a speed much slower than you would normally go there because of the mistake you’ve made in five and six.” I think for a lot of people, again, it’s easy to look at what people are doing in a race car and not think there’s much to it but of course, like many things, “The further you are from the shore, the deeper the ocean is,” Bob Kaplan says. The more I do it, the more I appreciate the gap between me and Sebastian Vettel.

Tim Ferriss: You’re wearing an Ayrton Senna shirt as we speak. For those people who don’t know who that is, you should absolutely watch a documentary called Senna, which was just incredible. Which I think helped me at least as someone who is completely naive to race car driving to become — to develop a high level of appreciation for just how hard it is to perform at a high level in those circumstances. I mean, it’s — and how incredibly dangerous it was at that point in time. Things have changed quite a bit, but when he was racing certainly, far more dangerous.

Peter Attia: Yeah, in the ’60s I’d say, sort of mid-, early- to mid-’60s into mid-’90s it was a staggeringly dangerous sport. Unacceptably so.

Tim Ferriss: Something occurred to me that I don’t think I’ve ever asked you before and that is have you considered, and maybe you already have something that fits this bill, but picking a hobby or something to obsess about that is a group activity or partner activity? Because it seems like most of the things I find you gravitate towards and become very obsessed about are even though there might be other humans around, they’re mostly solitary experiences.

Peter Attia: Yeah, you’re not the first person to ask me this and I think it’s a great point. I suspect the problem is I love these things. I do so much. I barely feel like I have as much time as I want to do them, but it might be the case that as my kids get older and I can do more of these things with them or different things with them, that that would sort of scratch that itch. There’s definitely something we said for it. I mean, I think ever since I was 13 I’ve been so — that was sort of a turning point I think in my personality or something where I just remember really gravitating towards individual things for a whole bunch of reasons I could probably unpack.

Tim Ferriss: I think that could be an entirely separate podcast, so racing, changing your mind.

Peter Attia: I would say the next one here on this list would be, and this is going to sound almost silly, but I’ve changed my mind on the benefits of exercise being much greater than I ever envisioned. I would probably classify as a borderline exercise addict. For me to say, “I now actually think exercise is incredible and has all these benefits,” is sort of a funny statement, which is not to say that I didn’t think it had benefits before, but I don’t think I understood or appreciated metabolically. If you just take one example, probably like four years ago, three years ago, I had one of our analysts do this exercise that took him about a year, which was with some direction around where to start, comb through all the literature on Alzheimer’s disease and get a sense of what tools in the toolkit would be most beneficial to prevent it or reduce the risk of it and or delay it.

I mean, it was — anything was on the table, what drug, what supplement, what this, what that. He came back and said, and we had a framework that was a very mechanistic framework. He came back and said, “It’s definitely exercise,” and I was like, “Dude, I mean, that sounds like such a politically correct thing to say, come back with like a real answer please. Like that just sounds dumb. It’s exercise. Like how can it be exercise?” Of course, he came back and made the case and in the end I believe that case, which is when you look at what exercise does from a vascular standpoint, from a growth factor standpoint, the creation of BDNF, brain derived neurotrophic factor, I really believe that, and again, you shouldn’t take the view that you should only do one thing, but if you’re really committed to brain health, you want to be exercising every day.

Tim Ferriss: What parameters are there on that exercise? When you say exercise for instance, there are people that view running as cardio, but then you in the case of resistance training are obviously utilizing the vascular system and your heart, but how do you think about type and dose?

Peter Attia: The literature is not crystal clear on that, but if you loosely take three types of exercise which is modest or low intensity, cardio, high intensity cardio, and strength training, if you took those as the three legs of the exercise stool, the good news is they all appear to increase BDNF. They all appear to have benefits though to different degrees on vascular tone, circulation, et cetera.

What I basically decided a couple of years ago or maybe a year ago was in the absence of better information, just having a portfolio approach to those in the context of the training for the Centenarian Olympics was the best of both worlds. In other words, my training is programmed through the Centenarian Olympics, which requires that you have training, a very specific type of training in all three of those legs coupled with the tabletop, which is stability. You have these four pieces of training, stability, strength, aerobic and anaerobic. By doing these every day or some combination of them every day, you also know that to at least to a first order approximation, you are getting the benefits of brain health. Then of course, I mean, while we’re just on that topic, I think sleep and periods of nutrient cycling and obviously the appropriate steps on nutrition.

Tim Ferriss: Nutrient cycling, meaning fast and famine?

Peter Attia: Yeah. I think some period of — 

Tim Ferriss: Or — I guess those are probably the same!

Peter Attia: Yeah, I know, feast and famine. Yeah.

Tim Ferriss: Be a great name for a podcast about fasting. Fast or Famine. Right. Feast or famine.

Peter Attia: It’s funny, like if you think about Silicon Valley right now, right? Like everybody is so obsessed with this nootropic and that nootropic, but I don’t think people understand is correct nutrition, exercise and sleep are far better nootropics than modafinil. I mean, modafinil might be one of the most potent nootropics out there, but it’s actually not that strong a nootropic. It’s actually kind of a weak nootropic actually by the literature.

Tim Ferriss: It is pretty amazing how many narcoleptics are Olympic-level sprinters though. You can prescribe modafinil. Anyway, Provigil, anti-narcolepsy drug. True story. Wow. Eight of the top 10 are narcoleptics. Who would’ve thought?

Peter Attia: That’s how they get so much time to train.

Tim Ferriss: Back in the good old days. What are things, and I know you’re a fan, correct me if I’m wrong but, of Matt Walker and a lot of his thinking on sleep, and I shouldn’t say thinking, I mean, his research related to sleep. How have you changed or better yet improved sleep protocol, things that you prescribe, not necessarily chemicals, to patients to improve sleep quality?

Peter Attia: I mean this sleep is a hard thing because it’s sort of like exercise in the sense that you can’t just give somebody a pill that makes sleep better. It really comes down to changing. You have to sort of accept you’re going to make behavior change. You have to prioritize this thing and it’s not just the eight hours you want to spend in bed. It’s the buildup to it. My sort of simplest toolkit, which is what I basically employ, I mean, most nights I don’t require a supplement to sleep. It’s not like I’m taking melatonin or even using Kirk Parsley supplementing. Those things I’m basically reserving for jet lag situations and things like that. If I’m doing everything correctly or fasting, that’s another time when you need a little bit of a boost, but if I’m doing everything correctly, using the right amount of blue light blocking glasses and I’ve recently switched to a new brand that I am fricking super jazzed about.

I mean, I find — first of all, they actually have published research that documents actually, I shouldn’t — I don’t know if it’s been published yet but anyway, they have data that I’ve actually seen that demonstrate how much they’re able to block blue light. At least according to my sort of sleep tracking metrics, they’re definitely contributing to much more deep sleep than I’ve seen historically.

Tim Ferriss: Can you name?

Peter Attia: Yes, yes. It’s called Felix Grey.

Tim Ferriss: F-E-L-I-X?

Peter Attia: Yes, Felix, and then Gray. Actually, you can see the box, right, it’s sitting over there. Those glasses sitting right over there are my Felix Grays and they’re just ridonculous.

Tim Ferriss: G-R — well, people can find it, A-Y or E-Y, one of the two.

Peter Attia: Yeah, I think it’s A-Y. I’m very religious about using those things.

Tim Ferriss: Felix Gray. Is that a real person or is it like Ashley Madison?

Peter Attia: I have no idea. Yeah, it might be in the latter, yeah. I use those things religiously. I’m very attentive to how much light is around me as the sun is going down. I’m also very attentive of not doing stupid things in the evening. We’ve talked a lot about this, not looking at email, not looking at social media, not looking at things that are going to potentially activate or phosphorylate me in any way.

Tim Ferriss: It’s another Peterism. “Don’t fucking phosphorylate me!”

Peter Attia: Also, just being very consistent in bedtime and wake up time, you know? When I’m really in the zone, it’s early to bed early to rise, so understanding your own chronotype. Are you an early or late chronotype? You and I’ve talked about this a lot. Incredible darkness in the actual room at night or using, I use this thing called the Alaska Bear Eye Shade. It’s like you can buy it on Amazon. It’s eight bucks. It’s like this little silky Alaska Bear. It’s the stupidest name ever. I don’t know why. I love it though. I have 20 Alaska Bears because I have them everywhere, so I’m never without one and I use — I just upgraded in the last six months from the chiliPAD to the OOLER, that’s O-O-L-E-R.

Tim Ferriss: Yeah, Kevin. Our buddy Kevin uses that as well.

Peter Attia: Yeah. I have no affiliations with any of these companies by the way, so I feel totally happy to just plug them shamelessly for no personal gain and the OOLER is a big step in the right — it’s really taken the chiliPAD to another level.

Tim Ferriss: First one’s on me, OOLER. I do take sponsorship money, but this has come up with Kevin. That’s a joke, people. In case you can’t take it, for fuck’s sake. Yeah. This has come up a couple times recently.

Peter Attia: The other thing is almost elimination of alcohol, so I’ll probably have a drink tonight, right? We’re going out to dinner like a bunch of friends getting together in Austin tonight. I mean, I’ll have a drink tonight probably.

Tim Ferriss: Yeah, you were the one who really put it on my — I certainly academically or intellectually understood that alcohol, even though it in some cases seems to make it easier to sleep, really disrupts quality of sleep or degrades quality of sleep. I really didn’t have an appreciation of that until — and this is one where I guess I don’t have any disclosure, but the where the Oura Ring really highlighted that for me, just how fucked my sleep was in terms of quality after say two and a half, three drinks.

Peter Attia: Yeah. I mean, I’m down to probably three or four drinks a month. That’s basically it. I’ve gone two months without a single drink. It’s like it has to be worth it because even at one drink, I’m going to experience some degradation of sleep.

Tim Ferriss: What type of degradation?

Peter Attia: It’s generally a reduction in REM for sure. A slight reduction in deep and an increase in fragmentation. You’re moved into that stage one, stage two space a bit more.

Tim Ferriss: Do you see a spike in, for lack of a specificity, the middle of the night in resting heart rate after you drink two or three drinks?

Peter Attia: Well, I see a higher resting heart rate period and a lower heart rate variability for sure, and a higher body temperature. I don’t know the last time I had two drinks in a night, but definitely it’s one to two is also a really big step up. Look, it’s everyone’s got to decide what they’re going to do and what their priorities are and I’m not here to say don’t drink at all, but I just have to say don’t be mindless in your drinking is sort of my point. Like if you’re going to drink, like make it really fricking worthwhile. Like do it for a reason. Don’t just do it because the alcohol is there.

Tim Ferriss: Is it, I don’t know if you’ve seen anything anecdotally or experienced this personally, is it just the ethanol or is there variability across vehicles for the alcohol itself, right? Is sipping tequila going to do less damage than for sort of the equivalent blood alcohol content achieved through red wine or something like that? I don’t know if you’ve looked at any of this yourself.

Peter Attia: I mean, anecdotally, it’s hard to know because your mind is also sort of feeding into a narrative around this stuff, but certainly drinking my Clase Azul Reposado seems to be less toxic than having — well, I’ll tell you, I mean, I’ve given up certain things like I don’t drink a Moscow mule anymore. Like I make a mean ass Moscow mule. I love that drink so much. I love the ginger beer, the lime, the whole ritual, but what I really decided was it’s just not worth combining sugar and alcohol together. Once in a while you can have sugar, once in a while you can have alcohol. Putting the two together is, I mean, you might as well just kick yourself in the nuts at that point. I just don’t want to do that. Certainly, mixed drinks are things that I think just don’t have a place in civil society if you care about your liver. If you don’t care about your liver, by all means, drink all the mixed drinks in the world.

Certain, I don’t experience this personally. I don’t seem to have any issue with red wine. I don’t get hangovers. I don’t get headaches, even if I have a couple glasses of red wine, but I’ve certainly seen patients who see a real difference in red wine consumption and it really seems to sit poorly with them. Similarly, if I drink like my sort of dark, favorite, super duper Belgian beer, I don’t seem to get any bloating or anything from it, but I’ve seen people who can’t really handle that stuff either.

Tim Ferriss: Now that would, although, it’s not a mixed drink — I mean, you’re getting plenty of maltose in that, right? I mean, you’re getting a nice little — 

Peter Attia: It’s the fructose that I’m most worried about. It’s the fructose and the ethanol combined I never want because they both go through this similar metabolic pathway and when they’re delivered in liquid form, when the fructose is in a liquid form and the ethanol, which of course is in a liquid form, now you’ve combined the velocity problem, the kinetic problem is working against you.

Tim Ferriss: What do you mean by that?

Peter Attia: Sugar as a liquid versus sugar as a solid behave differently and also the dose matters, but if you take a bolus of liquid sugar, it’s going to make it further down the GI tract than the solid. Certainly, in animals, the evidence, Lew Cantley actually published this study in Science about four months ago. You could basically take a mouse model that is primed to get colon cancer and you had three groups. One group is getting just a bolus of glucose. The other group is just getting a bolus of fructose liquid, and the other is getting a bolus of sugar, glucose and fructose together. You could make that animal explode in colon cancer with the sugar, the glucose fructose.

Peter Attia: Too much of a tangent to get into the why, but it turned out that that effect is probably not present with solid sugar, which does not mean solid sugar doesn’t come with its own problems, but it’s the ability of the transit time to get there quickly and not get absorbed because it’s not being held up in the upper part of the GI tract with fiber and other solid things that you’d have. Say if you were eating it in the form of fruit or even just in like a piece of cake for example. Again, I’m not suggesting, “Oh, it’s good to eat cake,” but the single worst thing you can do is drink your sugar.

Tim Ferriss: So many questions that I’m going to table for now. On this list, on these three lists I should say, is there anything that you think I would find particularly thought provoking or hilarious that you’d like to share?

Peter Attia: My next thing on the stupid list is the What If game. Have we talked about the What If game?

Tim Ferriss: I don’t think so.

Peter Attia: I don’t know when this started. Definitely before I got married, but I thought it was really funny to play this game of, “would you still like me if,” then I would make up something really stupid and even the game itself bugs my wife, but I make her do it. I make her go through the explanation of why it’s yes or no, so I still remember the very first one I did.

Tim Ferriss: Would you still like me if.

Peter Attia: Yes, and so the very first one I ever did, this is probably, we’d been dating for like a few months and she came over to my place and I made one of my favorite meals is like a curry stir fry, which is a very labor-intensive meal. You’re carving up a million different vegetables and all this other thing. We’re sitting there, we’re eating this thing. She’s like, “Oh, this is great,” and I was like, “Would you still like me if I was the exact same guy,” it always gets prefaced by that, “Would you still like me if I was the exact same guy, but instead of using a knife to cut these, I was like this really flexible guy with long toenails and I used my toenails to cut them? I sat cross-legged on the floor and I sliced and diced all the vegetables using my toenails but I was, everything else about me is the same.”

Tim Ferriss: And she’s like, “Ugh.”

Peter Attia: I was like, “I want you to like literally picture this. I’m the same guy. Everything about me is the same except for this one little thing, which is I just like to use my toenails to cut the vegetables instead of a knife and a chopping block.” Then she sort of humored me with that and I just went over and over and over again. To this day, I still play this game constantly. I actually asked her before I came over, I was like, “Do you remember some of the ones that really like annoyed you when I would ask these?” She reminded me of a few. One of them, we were in Italy this summer and we walk into a department store and they have this big bright red Speedo with a gold belt and I was like, “Would you like me if I was the exact same guy but I only wore this as my shorts? I would still wear shoes and a shirt, but instead of wearing like the shorts that I’m wearing now, like I would only wear this bright red Speedo with the big gold belt.”

Tim Ferriss: The European [Greatest] American Hero.

Peter Attia: Yes.

Tim Ferriss: Yeah.

Peter Attia: And she’s like, “Eh, probably not.” And I’m like — and then, of course, whenever she says that, I’m always like, “How can you be so superficial?” How can that one thing be such a deal breaker? Another one that she remembered was car dancing. I was like, “What if I was the exact same guy, but I would dance like crazy while I was driving?” And then I would mock — do you remember in Sixteen Candles when Anthony Michael Hall is dancing around Molly Ringwald at the dance?

Tim Ferriss: Yes.

Peter Attia: I would do that dance, but I always did that while driving. And I was like, “What if I was the exact same guy, but I did that?” “What if I wanted to watch The Smurfs for two hours every single day?” I loved The Smurfs.

Tim Ferriss: The Smurfs?

Peter Attia: The TV show. Remember the old — 

Tim Ferriss: The TV show?

Peter Attia: Yes.

Tim Ferriss: Not movie adaptation.

Peter Attia: That’s right. Right, right, right. So I loved Hefty Smurf and I was totally obsessed with him.

Tim Ferriss: Hefty?

Peter Attia: Remember Hefty Smurf?

Tim Ferriss: Oh, I don’t.

Peter Attia: He was like the really muscular —

Tim Ferriss: Oh, I don’t remember Hefty. All right.

Peter Attia: Yeah, yeah, yeah. Yeah. Yeah. And so anyway I just had like a long list of these. And I would just always do it. I always play the what — I love playing the What If game. And I’m actually kind of amazed at the amount of times she would just veto me based on the stupid thing I said.

Tim Ferriss: Well I would imagine, at some point, she’s like, “How can I — he’s not going to let me out of this. So how do I cut this short or make it interesting for myself?”

Peter Attia: But if anybody else is listening to this and you’re trying to just insert a little spice in your life, I can’t suggest the What If game highly enough. It’s really where you’ll find out where the rubber hits the road.

Tim Ferriss: Oh, yeah. “How much would it take? How much would I have to pay you to…?” That’s another good one.

Peter Attia: Yeah. Yeah, yeah that’s —

Tim Ferriss: That one devolves quickly, in my experience, if more than two guys are involved generally speaking.

Peter Attia: Especially if one of them is Kevin Rose.

Tim Ferriss: It gets awful very quickly. #KevKev.

Peter Attia: Sorry. Sorry, brother.

Tim Ferriss: I remember one time — I just have to give Kevin some shit since we know him so well. I don’t know if I have ever talked about this publicly. But Kevin was sort of famous, I don’t think he does this as much anymore, but he was famous among the friend group I had in the Bay Area for betting people to do things. Right? “I’ll give you whatever amount if you do this.” Right? And he would do this all the time to try to get people in trouble or — not in a malevolent way, mind you, just to like create mischief. He’d be like, “I’ll give you X if you do this.” And we were out at a steakhouse in San Francisco and there was this bottle of Tabasco or something like that. And we’re like 80 percent done with the meal. And I had ordered surf and turf and people had ordered various things. And Kevin goes, “If you drink that whole bottle of hot sauce, I’ll give you $20.” And I was like, “Okay, timeout. Kevin, you’re not fucking poor and you’re offering me $20 to — “

Peter Attia: To basically destroy my GI tract.

Tim Ferriss: Yeah, destroy my GI tract. Maybe have to tap out for two days or go to the hospital. How fucking cheap are you? That’s embarrassing. You should be ashamed of yourself. And I had just finished the lobster tails. Or, no, there was more to it. It was like a full lobster or half shell or whatever. And I was working on my steak and I said, “You know what, $20? That’s bullshit. I’ll give you $10,000 if you can eat this lobster shell.” This is in front of an entire table. And, to his credit, he actually took a crack at it. And he ate like an inch and a half of one of the antenna. And he was like, “I can’t do this.” But he did give it a shot. So, all credit due.

Peter Attia: So here’s another question. How many times in the history of, let’s just limit it to Homo sapiens, do you think that game has been played by females?

Tim Ferriss: If we’re talking — just because this is getting, wading, into dangerous territory. But if we’re talking just knee-jerk response? When it gets to dangerous levels of stupidity, I’d definitely put that on the low side. Very few.

Peter Attia: Yeah. I just — I don’t know what it is about guys that make us so dumb when it comes to this stuff.

Tim Ferriss: Yeah, I mean, there’s — just to maybe give people a showcase — 

Peter Attia: By the way, for context, in high school for $2 I drank an entire bottle, one liter, 750 ML of lemon juice.

Tim Ferriss: Ugh. Ugh.

Peter Attia: You know that real lemon lemon juice stuff?

Tim Ferriss: Yeah, ugh.

Peter Attia: 750 ML. For $2 I drank it in high school.

Tim Ferriss: Terrible.

Peter Attia: Oh, I pretty much perforated my stomach.

Tim Ferriss: Terrible.

Peter Attia: But it was like, “Oh, well you’re, you’re egging me on to do this? Oh, yeah, I’ll do that.”

Tim Ferriss: Yeah. There’s are many Instagram accounts that I sort of rubber neck at watching. And this probably came via one of my friends who shall remain nameless. But I’m pretty sure it’s just called Doing Things Wrong. And it’s basically people fucking up like everything you can imagine possible: BMX bike riding, parkour, whatever. And the ratio, the male-female ratio, is astonishing. It’s astonishing and also completely unsurprising at the same time. It’s just like all guys. And you’re like — you see it coming from a mile away. You’re like “Terrible, terrible, terrible idea.” And then, boom, pay off. Yeah. Turns out that was a bad idea.

Peter Attia: It’s just sort of funny to think it’s possible our species couldn’t have got here. It’s possible. There’s at least another parallel universe that didn’t quite make it because the male reproductive end of the bargain could not be lived up to due to just constant stupidity.

Tim Ferriss: Yeah, I don’t — I think it’s a fine line, right? I mean, I don’t think we’re that far away from that already. Right? It’s just —

Peter Attia: Well now it’s different because evolution isn’t the thing that’s — it’s not going to be natural selection that kills us now, we’ll just kill ourselves directly. But natural selection could have basically weeded us out just based on male stupidity.

Tim Ferriss: Oh, yeah. I mean, I don’t have kids yet and I’m astonished that I haven’t won the Darwin Award yet. Right? At this point. All right, let’s do one more excited or changed mind on that you think might be a good closer.

Peter Attia: Well the other one I had on excited was, which I really owe a lot of credit to you, is this whole sort of podcasting thing. And learning, learning might even be too strong a word, practicing this art of interviewing. It is. So this whole thing started as sort of an experiment a year-and-a-half ago. And I just didn’t — I couldn’t have imagined how enjoyable it is. I mean, I think what you’re doing today is way more fun than what I’m doing. I don’t actually like being asked questions that much anymore. But I love asking questions.

Tim Ferriss: Yeah.

Peter Attia: And I find myself listening to podcasts much more than I ever did before. And listening to, now, two things. One is what’s the content? But also, and perhaps as importantly if not more importantly, is how is this interview extracting that? How is this interviewer — what are they thinking? What would I have thought at that moment? Did they think of — oh, they went down a path I wouldn’t have thought of. Okay, how can I — what can I take away from that? So the good side of that is I think it allows me to try to become better at this craft. The downside, honestly, is I feel much more pressure now. I feel — and not to the point where it’s taking away or detracting from the experience. But I’ve had to now go back and listen to some of my own podcasts, because that’s one way you learn is you sort of have to go back and listen to them. And that’s, as you probably know, that’s a very painful thing to do. Do you ever listen to your own podcast?

Tim Ferriss: Oh, yeah. Yeah, yeah.

Peter Attia: Yeah.

Tim Ferriss: Absolutely.

Peter Attia: I think you have to, if you want to get better at it.

Tim Ferriss: Yeah, you have to. I mean, it’s like reviewing footage of a training session or something.

Peter Attia: Yeah.

Tim Ferriss: It’s a requirement, I think, if you want to do post-game analysis and improve what you’re doing. But it can be really painful.

Peter Attia: Yeah, it’s super tough. So it is, again, yet another thing like archery, like race car driving where there’s this opportunity to be somewhat critical in the spirit of trying to get better. But it’s also opened me up to a new world I never really paid attention to before, which is journalism. Sort of TV journalism or radio journalism where you’ve got to be able to think on your feet, you’ve got to be able to multitask. And for me, I don’t know if you feel this way, but I think the hardest thing is to somehow parallel process being engaged in the discussion that you’re having, but allowing a part of your brain to be thinking about where you are on a path and where you want to go. And those are — that is, that’s like next level ninja moves.

Tim Ferriss: It is. What surprised me maybe the most about the podcast interviewing game or the format of one-on-one, one-hour plus interviews is how coachable and improvable many of the component skills are. I’ve really been astonished by that. And one example of that would be the ability to bookmark, even when not taking notes. Right now I took notes throughout this conversation in case I wanted to come back to something. But, even in the case of not taking notes, the ability to bookmark departure points where your interviewee goes off in a different direction and the capacity to then return to those bookmarks as if you had flagged them. That is an ability that — I mean, let’s throw an arbitrary number on it, like 10X to my ability to do that in any conversation vis-a-vis the podcast. And it makes you wonder what are the cognitive — what’s the mechanism behind that? And does that transfer to anything else? Like am I, unbeknownst to me, developing other cognitive functions that correlate to that? Right? And certainly listening. Listening to your own audio really showcases any ticks that you have or any pet phrases or any words that you tend to start too many sentences with. I used to go “So, so, so, so.” And I listened to this audio and it was agonizing. And then there was one interview, in particular, I’d love to hear. I know that intros drove you completely insane for a period of time.

Peter Attia: They still do.

Tim Ferriss: Okay, so we can come back to that. I don’t think people fully appreciate how torturous that process can be. But I interviewed Ed Catmull who, I think he’s still the president of Pixar, but at the time was president of Pixar. And he was coming out with a book, a great book actually, I think it’s Creativity, Inc. And he was the first guest ever on the podcast who I’d never had a prior conversation with. Or I never had a prior — I’d never had a conversation with him prior to the recording. And there was a mix up in communication and he thought the podcast was a lot shorter than my intended time. Right? He’s a busy guy. And he wasn’t angry, he wasn’t hypercritical. But it got off to a tense start because I was like, “How do I reconcile this? Can we go longer?” And it was just an unexpected variable to deal with. And I was very nervous going into it to begin with. And did the interview, I was quite happy with it all things considered.

Tim Ferriss: And then I’m looking at feedback on Twitter. And I see three tweets in a row that are “Mmm…mmm…” and I see a few of these and I’m like, “What the fuck is going on?” And I go back and I listen to the audio. And every time he said anything, I went Mm-hmm (affirmative) Mm-hmm (affirmative) Mm-hmm (affirmative). For a fucking hour. An hour-and-a-half, whatever it was. And I just could not believe how fucking oblivious I was to the fact that I was doing that every 15 seconds. And I could think of 15 of those. Right?

Peter Attia: Yeah.

Tim Ferriss: And, “Oh.” Or, at one point, I don’t know what it was it was another nervous tick in one of my interviews. And I was going [chewing mouth noises]. Sounded like I had a fucking chipmunk on my shoulder chewing acorns for the whole interview. Oh, torture.

Peter Attia: I mean, those things stress me out. But not nearly as much as the bigger picture of missing the exit. If an interview is a discussion where you’re driving down a road, it’s like missing a side road.

Tim Ferriss: Yeah.

Peter Attia: Missing a side road and getting lost. And, I don’t know, I mean I think I am better than I was at the outset. But I think this is definitely the steepest learning curve. And there’s so — I mean, I have an aspiration for what it can be. And I do love listening to great interviewers. Now, in the podcast space, it’s a bit misleading. So if you listen to somebody like Steve Dubner, who I think is fantastic, that type of a podcast is produced.

Tim Ferriss: Freakonomics?

Peter Attia: Yes. Yeah. And so that’s a little bit different. But, I mean, I love listening to Katie Couric. I love listening to people do long-form interviews. And I’ve asked — I’ve actually asked Katie for some advice, which has been great. And I — any chance I get to ask somebody who does this for a living.

Tim Ferriss: Do you recall what you asked her and what she responded with? Or anything that you’ve picked up from good, which is not always — 

Peter Attia: I’m trying what the best piece of advice I’ve been given so far.

Tim Ferriss: — good interviews. Or any good advice?

Peter Attia: Well, I’ll definitely tell you at the outset the hardest part I had was, and it’s embarrassing because you feel like such an idiot when you’re doing it and you realize it as it happens, is you’re talking over the person. And I just think, in your excitement, you sometimes just like, “Oh, okay. But I have another question now.” And it’s like, “I don’t want to forget these other — I don’t want to forget all these questions.” So that’s something where it’s a lot easier in person, because body language makes that easier to avoid. I do most of my interviews in person so that that’s a bit easier. I think, in the end, I’ve learned it comes down to prep. You really — the better interviews are ones where I feel like I’m more prepared. And the interviews that I come out of where I think, “Man, I can’t believe I didn’t know all of these other things that would have allowed me to take this discussion in another direction.”

Tim Ferriss: There are also many different styles of interviewing, right? I remember early on I was very lucky, I don’t know how this happened, to be introduced to one of the head researchers if not the head researcher for Inside The Actor’s Studio. And I asked him if he’d be willing to look at transcripts of some of my interviews to offer pointers or observations. And it was very, very valuable. And the point that he made, as a preface to feedback, was exactly what I said. And that is there are many different ways to skin the cat. And James Lipton, who is fantastic in his role as the interviewer/host of Inside The Actor’s Studio, almost never changes the order of questions. Once he has a stack of questions on blue cards, he will not deviate. He, almost without exception, knows the answers to every question he’s going to ask. And that’s, say, one end of the spectrum. Then you have a Larry King and there are others of sort of Larry King’s school of interviewing who go in, I’m not going to say blind, but intentionally with beginner mind. Not knowing much about the interviewee unless they’ve met them before so that they can ask questions kind of from first principles.

Peter Attia: Mm-hmm (affirmative).

Tim Ferriss: Right? Mimicking the listener’s experience. And then you have a lot in-between. You have a ton in-between. And, as you noted, the produced shows like This American Life or Freakonomics are spectacularly good. But they are very different from a minimally edited, long form interview of, say, two hours or where we are to almost two-and-a-half hours. And the ability to compartmentalize, like you said to parallel process, is also something that I could not do in the beginning. And I’m not saying I’m the epitome of skill or ability with it now, but it does seem to be a faculty that you can cultivate. Who are other interviewers you’ve paid a lot of attention to? I mean I, certainly when I was getting started, I listened to and still do listen to quite a bit of of Rogan, Joe Rogan.

Peter Attia: Mm-hmm (affirmative).

Tim Ferriss: Marc Maron. Very different styles, right? Both very skilled, but very different styles. I think Steve Rinella actually is a fantastic interviewer. He’s such a subject matter expert with a lot of what he does. And there are many, many other people who are just outstanding. But is there anyone who —

Peter Attia: I think part of the problem is I’m still trying to figure out where I am on that spectrum.

Tim Ferriss: Mm-hmm (affirmative).

Peter Attia: So I think one of the goals I have for next year is to hone this craft even more and actually sort of figure out what my voice is. And then sort of start to double down on the learning around that. Now of course, again, you could argue that being malleable would be the best outcome, being able to do one extreme or the other. I don’t go into interviews with questions, but I go in with a lot of prep. I have a team that helps with that. So I go in with four or five, sometimes — I did a podcast a week ago with 28 pages of notes going in. But none of them were questions, it was just content.

Tim Ferriss: Do you refer to those pages in the midst of the interview?

Peter Attia: Yeah. So what I usually do is I’ll say to the person I’m interviewing, and sometimes I don’t, by the way.

Tim Ferriss: And actually, if you don’t mind me interrupting and talking on top of you for a second, what do the prep instructions look like? When your team helps you prep what are their marching orders? What do they do?

Peter Attia: It varies totally by the podcast and subject matter.

Tim Ferriss: All right, give me an example.

Peter Attia: But so for this one, for the 28-page one, this was a podcast which was very difficult because I was interviewing two people. So that’s — I’ve only done that three times, or maybe even twice, and it’s much harder to interview two people. And, like you, these are people — like the example you gave, I’d never spoken with them before. So I identified them as subject matter experts. The subject was THC, CBD, all things related to cannabis. So I identified them as exactly the two smartest people I wanted to talk to in the room, but had never spoken. It was all through email, no communication otherwise. And I said to my team, “Look, these are things I want to understand that I don’t know. I believe these are things the public wants to know. I need a dossier that is the best available knowledge you have on all of these topics. And then I’m going to basically look where the gaps are and I’m going to sort of run the sled between the gaps in the snow.”

Tim Ferriss: Did you send five to 10 bullets per silo, in terms of what Peter wants to know, what the public might want to know? I mean, how much are you sending to your team as a starting point?

Peter Attia: So in that case, I’m trying to think. I think Jess took the lead on that analysis. No, I think actually Jess took the first cut. So she came back with kind of 10 pages of stuff. And then I was like, “Okay, let me digest this for a couple.”

Tim Ferriss: But what did you provide her first?

Peter Attia: Literally nothing, blank space.

Tim Ferriss: Oh, it was blank space?

Peter Attia: Yeah, total blank space. And then she came back. And then I reshaped it and said, “Okay, well I also need to know more about this, more about this, more about this. This is good here, thank you. This one is good, but can you give me a little bit more insight?” So that’s one extreme end of the spectrum. And then other podcasts that, I mean, I have podcasts where I literally go in with nothing except blank paper to take notes on while we’re speaking. Kind of like what you and I are doing right now for you, where there’s nothing you need to prep for this type of an interview. And then there’s very technical ones.

Tim Ferriss: Actually I do have 28 pages to my right on egg-boxing, but we didn’t manage to fully unpack that. Next time.

Peter Attia: I mean, it’s just — it’s such a nascent space. The bottom line is it’s — I’m a little embarrassed sometimes when I listen to myself interview. When you hear it the second time you think, “How did you miss that thing that they said? They said something so important. They were opening a door here and you didn’t even go in that door.” And that’s another, I think, part of what the people who are good at this can do is they can release their own agenda and sometimes go where the story is more interesting.

Tim Ferriss: Yeah.

Peter Attia: And I’ve definitely seen many examples of how I’ve missed that opportunity.

Tim Ferriss: I had a lot of trouble with that, also. And a fixation on remembering questions, which is actually part of the reason why I still often recommend to novice podcasters that they prerecord a number of episodes via phone first, meaning via Skype an e-cam call recorder or Zencastr, because it allows the ability to look at notes so that you’re not as preoccupied. What I’ve found very helpful, for myself, is more of a structural prep than a content prep in the sense that I will decide, as a placeholder and it’s not something that I fixate on, but to have say a Post-it note to my side which says, “First 30 this type of stuff. Next 30 this type of stuff. Next 30 this type of stuff.” But no specific questions.

Peter Attia: Yeah.

Tim Ferriss: And then I will look at the recording time and segue roughly at those two pivot points. The other thing that I found really, really helpful — and this mirrors how I’ve done a lot of my best writing, which I haven’t done in quite a while and I’m going to be getting back into writing, and that is knowing which handful of questions I’m going to start with. And I might only get through two. And then where I want to bookend it. And questions I think could lead to a grand finale or a nice way to wrap up. And then in-between it’s just looking for the side streets.

Peter Attia: Yeah.

Tim Ferriss: The entire time.

Peter Attia: It’s a fun craft. I mean, again, this is sort of like archery, sort of like driving a race car. Anybody can do it, it’s hard to do really, really well.

Tim Ferriss: Yeah, it’s like — I think it’s Bushnell’s Law? This was in the gaming world, it was in the context of Atari at the time. But I want to say that the quote is roughly, “A great game is easy to learn, hard to master.”

Peter Attia: Mm-hmm (affirmative).

Tim Ferriss: Yeah. That’ll keep you moving for a long time.

Peter Attia: Yeah. Oh, absolutely, well said.

Tim Ferriss: So, Peter, tell people where they can find you if they want to listen to the most meticulous dissection of subjects like THC, CBD, MRI, longevity. You’ve got all manner of subjects. I mean, you also introduced me to Ryan Flaherty, the savant of speed when it comes to physical training. You cover a lot. The podcast is?

Peter Attia: The Drive.

Tim Ferriss: The Drive.

Peter Attia: And I exist on any sort of whatever. My website, Twitter, Instagram is all Peter Attia, MD.

Tim Ferriss: Peterattiamd.com.

Peter Attia: And that’s only because Peter Attia was taken. I hate having MD. I can’t say it without thinking about Meet The Parents. “Dr Bob. Bob MD.” My wife still makes fun of me for that, “Peter Attia, MD.”

Tim Ferriss: If you had a blog post, or series of blog posts, that you would suggest people start with if they want to explore your thinking in the written medium where would you suggest people start? Is there anywhere you would suggest they start?

Peter Attia: We have a five-part series on science, understanding science, called Studying Studies.

Tim Ferriss: Yeah, that’s so good.

Peter Attia: Yeah, I think that’s a helpful one if you consume news about health.

Tim Ferriss: Which you do. Right?

Peter Attia: It’s hard not to, yeah.

Tim Ferriss: Yeah, if you read — if you are exposed to media that contain any health claims whatsoever then chances are you’re coming across — 

Peter Attia: Yeah, so that’s — and I can’t — 

Tim Ferriss: — “studies show…”

Peter Attia: Yeah, exactly. Yeah.

Tim Ferriss: — “bananas increase risk of colorectal cancer 47 percent.”

Peter Attia: Right, right, right.

Tim Ferriss: Wait a second, now.

Peter Attia: Yeah, yeah, yeah. So, if you want to get through the fine print. So Studying Studies, which Bob Kaplan and I wrote in 2017 I believe. I think that’s a great place to start for folks.

Tim Ferriss: Great. And I’ll link to that at timferrissmd.com. No, at — 

Peter Attia: And I’ll shamelessly plug for our Sunday newsletter, which I know you should like.

Tim Ferriss: Yeah, you should. You should.

Peter Attia: So we — you can sign up for, what I describe as, a non-lame weekly email.

Tim Ferriss: I get your emails and there aren’t that many emails that I subscribe to, because I have enough in my inbox. But yours is one I get, one of the few. And I will link to the newsletter, your newsletter, and everything else that we’ve talked about at tim.blog/podcast. Just search Attia, A-T-T-I-A, and it’ll pop right up. Anything else you’d like to say? Closing comments? Limericks? Anything else?

Peter Attia: I don’t think so. I think — I could certainly offer about 20 more dumb things I do, but we could save that for another day.

Tim Ferriss: We could save that for a follow-up. If you guys enjoyed the format, please let me know in the blog comments that accompany this podcast. Or on Twitter @tferris, two R’s, two S’s. Just let me know if you liked or hated this format or anything in-between. The kind of five things with person X. I might do three things with, five things with, whatever we get the idea. Kind of excited about, changed mind about, and then stupid, absurd things. Thinking about doing more of these because it’s a damn easy plug-and-play format for one thing. And, Peter, we have a dinner date. And we will get to that at some time in the very, very near future. So I guess autophagy be damned, here comes the calories. And thanks for making the time, man.

Peter Attia: Thank you.

The Tim Ferriss Show is one of the most popular podcasts in the world with over 400 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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4 Replies to “The Tim Ferriss Show Transcripts: Peter Attia, M.D. — Fasting, Metformin, Athletic Performance, and More (#398)”

  1. Tim- In your podcast with Adam Grant you mentioned that you are feeling an overwhelming impulse to “disappear “, to get away”. Here’s an idea proposed as a solution: “Follow the feeling”, the path is being lit for you. Take 4 thought leaders and men that you respect and go out into the wilderness for a week on silent retreat. Silence, no words, 5 men, 5 days… Then podcast your experience with each of them. You may find this decompression period to be transformative. This may give you the time you need to “follow the feeling”and have the experience you seek internally, and externally become one with nature. No external distractions unless you choose to see them. I wish you peace.

    Yours in service,

    Ryan