Peter Attia: Longevity, Diet, And Finding The Drive

I head to San Diego, via Mexico (relevant shortly) to catch up with one of the great health leaders of the planet, Dr. Peter Attia.

Peter is a prominent longevity physician, ketogenic diet expert, ultra-endurance athlete, crazy self-experimenter (always in the name of science!), and as of July 2018 launch, host of an outstanding new podcast called The Drive. His A-game is now all organized at PeterAttiaMD.com. Sign up for his newsletter, subscribe to The Drive podcast and digest the great “Nerd Safari” articles on his website.

Hang on for a wild ride with Peter and learn about the best way to live a long, healthy life, escape the trap of disease and dysfunction that have reached epidemic proportions today, and go off onto interesting tangents. As Peter describes on his Twitter bio, he is a man obsessed with living a passionate and intense life, whether in his career in health and medicine or his hobbies like auto racing, archery, well-chronicled dietary and fitness experiments, or trying to be a super dad to kids 10, 4 and 1.

Yes, Peter is a rare and exalted breed of chingón– Spanish for bad ass. Dropping Spanish here is appropriate because I had just returned from a Mexico vacation the night before our podcast, and with a only a couple minutes left in the interview, I suddenly became super dizzy and sweaty and had to collapse onto the couch of Peter’s guest house! After a recovery period under the watchful eye of a physician (that would be Peter) and a Nurse Practitioner (Peter’s wife Jill, who arrived from the beach to discover this interesting situation), we finished the show with a perfectly-timed cameo from daughter Olivia. Now you have to listen to the whole show!

Anyway, Peter lives his life with passion and intensity – attributes sorely missing as we grow more affluent, screen-addicted, and lazy in modern society. You’ll pick up on Peter’s A-game when he goes off on motorists who mess with cyclists on the road. He relates how lost a friend from a cycling accident, so this issue understandably strikes a deep chord. I also picked up on this theme when he arrived at Peter’s house as he was having an extremely animated telephone conversation with the f-word getting lots of action. He explained that he was talking to a close business associate (Bob Kaplan, head research analyst for PeterAttiaMD.com) and how they benefit from venting to each other on occasion! In the next breath, he explained the importance of compartmentalizing and controlling emotions, relating that he would never want his kids to hear such a phone call because they are too young to understand the context.

Peter’s calling is to fight the epic battle to cure diabetes, heart disease, cancer, and neurodegenerative disease. As evolutionary health enthusiasts realize, this is truly a battle against the forces of flawed and dated conventional wisdom, and manipulative marketing from big food and big pharma entities. Watch Peter’s amazing TED MED talk where he breaks down at the end, apologizing for feeling judgmental about a diabetes patient, while suggesting that we may have the story of obesity and diabetes all wrong. As Gary Taubes wrote in his book, Why We Get Fat, “obesity and sloth are not causes of obesity, they are symptoms.” What this means is that getting fat is your body’s effort to mitigate the damage caused by the disease condition of insulin resistance.

Are you with me? People who put together the one-two punch of unlucky genes and high carbohydrate dietary patterns become insulin resistant and get fat. The high insulin-producing diet messes up their appetite and fat storage hormones so that they are hungry too often, more likely to end up storing ingested calories as fat, and feel too tired to be physically active. Commanding a human to not eat when they’re hungry or to get their ass off the couch to exercise when their bloodstream is literally starved of energy, is missing the mark. In his TED MED talk, Peter draws the analogy of doctors treating patients for bruises caused by repeated whacking shin on a coffee table, when you might instead just move the coffee table!

Peter’s reflections on this important matter started years ago when he was adding excess body fat despite doing literally hours of endurance training each day in preparation for his 2006 swim from Catalina Island to Los Angeles (21 miles!) He was diagnosed as pre-diabetic despite his athletic (but massively carbohydrate-dependent) lifestyle, which is as good a wakeup call as you can imagine to second guess the mainstream notions that portion control and vigorous exercise are the keys to staying trim and healthy.

The show gets rolling with Peter discussing how to avoid the most common disease conditions of modern life: heart disease, cancer, and neurodegenerative disease. Peter’s approach is to tackle the “low hanging fruit” and reach 80 percent of your longevity potential. While he’s been deep into study of diet, and himself remained in strict nutritional ketosis for three years from 2011 to 2014 (monitoring his glucose levels with a surgically implanted glucose monitor in his abdomen), he prefers to dispense the simple advice of eating wholesome natural foods and staying away from processed modern foods. Beyond optimizing your diet, implementing some sensible exercise habits and obtaining adequate sleep get you pretty darn far down the road to longevity. Simple as that, but Peter relates that many of us know what to do and simply don’t do it for myriad reasons.

Peter’s been on many podcasts with detailed scientific discussion of his longevity and scientific interests, so pursuant to the Get Over Yourself mission of emphasizing the unplugged, we go off on some tangents—all credit to Peter here—and cover some stuff you might not hear from his other show appearances. For example, he delivers some impassioned insights that may save the life of a road cyclist out there listening someday. No kidding.

Peter discusses how insulin AUC (area under the curve) is perhaps his favorite longevity marker. Impossible to measure practically, but the concept is that you produce an optimally minimal amount of insulin over your lifetime to get the job done (deliver nutrients to cells throughout the body) and how this goal might reconcile with the seemingly disparate idea of eating plenty of nutritious calories to fuel athletic performance and recovery. It gets a little sciency at times but you’ll get quickly brought back to some relevant takeaway points, especially if you do a little googling as needed. The show progressed into the science of athletic peak performance and genetics, with cameos here for Michael Phelps, Usain Bolt, and Tour de France champ Chris Froome.

You will pick up some great tips about being a peak performer because this guy is like no other; he just goes hard in every direction and lives by this fundamental principle of pursuing mastery in whatever you do. Be sure to subscribe to his newsletter and podcast at peterattiamd.com if you care about getting the very best health information. Here’s a great quote from his introductory website message to give you a further appreciation for what Peter is all about: “If the title of an article starts with “8 Essential Foods for…,” or the like, chances are it’s not worth reading. To really learn something requires contemplation and thinking—even as the reader—and over time this leads to new insights, which is one of the most rewarding experiences I have come to know. It’s the reason why I get so excited when a patient asks me a question I don’t know the answer to. I want to learn more each day, ask better questions, create and connect more dots, and engage my curiosity.”

Time Stamps:

Peter is working with an exciting research team of people from many different backgrounds always searching for answers to longevity. [08:04]

His medical practice is located in San Diego and New York City basically helping to implement a model into the patient’s own individual needs. It differs greatly from regular medical practice. [00:11:25]

Peter’s recommendations to avoid disease. [00:13:32]

What about eating things in moderation? [00:18:04]

Depleted glycogen is not a problem for ketogenic athletes. [00:22:03]

How does Peter’s current diet work when he is in and out of ketosis? [00:24:49]

Does he ever cheat? [00:29:00]

Can one get up and over one’s previous fitness level by virtue of having better fat burning? [00:32:58]
Is the amount of insulin one produces affecting longevity? [00:33:46]

Peter has a quarterly eating system he describes here. (Ketosis, fasting, nutritional ketosis, time restricted feeding.)[00:37:49]

What you eat post workout makes a real difference in how one recovers. [00:39:42]

What is the psychology that comes into play when one gets emotional? [00:44:20]

Road biking is one of the most dangerous activities in the world. [00:49:10]

Peter trained and then swam from Catalina Island to San Pedro, California in 10 hours. Wasn’t he worried about sharks? [00:54:54]

When you are a performing athlete, can you still have excess body weight? [00:58:22]

What would be the ideal physique of a good marathon runner? Aerodynamics are important. [01:00:10]

Swimming is different because of the density of the water. One wants to avoid drag. [01:07:50]

The disastrous effects of overtraining are underestimated. [01:10:22]

When you compare yourself with other accomplished athletes, you can learn a great deal. [01:12:11]

What are Peter’s athletic goals? He talks about working to improve his skills in varied activities. [01:15:26]

QUOTES:

“The journey of getting better at something is very important.”
“The best outcomes are when you are cycling between periods of anabolism and catabolism.”
“Thrust and drag avoidance are everything in swimming.”

Listen:

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SHOW TRANSCRIPTION:

Brad Kearns: Welcome to the Get Over Yourself Podcast. This is Brad Kearns.

Peter Attia: “People have different needs, right? There’s like a hierarchy of needs, but I think that for many people, and certainly for me, mastery is a need. The journey, like the journey of getting better at something is very important.

“You might actually produce the best outcome if you’re cycling periods of growth and autophagy. Periods of anabolism and catabolism, and that is kind of my latest thinking on this topic.”

Brad Kearns: Hi listeners, I’m so excited to introduce my wonderful show with Dr. Peter Attia. What a privilege it was to visit him at his home in San Diego and get into it, with one of the world’s leading longevity physicians, an expert on the ketogenic diet. An ultra-endurance athlete who’s performed amazing feats like swimming from Catalina to Los Angeles, 21-mile endurance swim. He’s known as a big-time self-experimenter. Everything chronicled beautifully in the name of forwarding science. Doing intensive dietary modification experiments and proving the amazing adaptations the body can make when it becomes fat adapted.

Now, his A-game is all organized at peterattiamd.com. So, go there, sign up for the newsletter, subscribe to his new podcast he started in the summer of 2018. It’s called The Drive. A fantastic show. The title has disparate meanings because he likes to race automobiles, and he’s also a driven guy, man. You’re not going to find too many people that go as hard as this guy in all directions.

As he describes on his Twitter comment biography, he’s a man obsessed with living a passionate and intense life and detailing all his passions, especially in the medical and the scientific realm. And of course, his passions for peak athletic performance, his auto racing, his archery, his endurance feats, his extreme self-experimentation, and also trying to be a super dad to kids ten, four and one. Yes, Peter is for sure a chingón. That’s a Spanish word that translates into “a bad ass”.

I’m dropping Spanish here appropriately because the night before the show, I returned from Mexico, vacation in Mexico. Felt great. Had a nice workout in the morning, cruised down the coast of southern Cal to San Diego, and everything was going well until the last couple of minutes of the interview. Right before we were about to finish, all of a sudden, I got sweaty and dizzy and had to pass out on the guy’s couch in his guest house.

Oh my gosh, what an epic fail for a podcast. Here he is, turning from podcast guest into doctor. His wife walks in, who I’ve never met. She’s a nurse practitioner. So, I had these medical professionals checking me out, giving me a glass of water, telling me to settle down. I felt better and rallied for a nice little finish to the podcast. And we had an epic cameo by his daughter who also helped launch his podcast with the very first show. You’ve got to listen to her on there. And you’ve got to listen to the whole thing on this show.

Anyway, my favorite thing about Peter, is he lives his life with tremendous passion and intensity. And I feel like this is an attribute that’s sorely missing these days as we get into society that’s ever more affluent and comfortable, and addicted to screen entertainment and generally becoming more lazy in many ways. And you will pick up on Peter’s passionate intensity for sure when we go on a little tangent in the show, and he goes off on the topic of motorists scaring bike riders out on the road. He’s a road cyclist. He lost a friend to a car accident. So, obviously this issue touches a nerve.

I also, when I arrived to his home, he was going off on a phone call dropping the F-bomb here and there and just hitting it hard. And he later explained, he was talking to his close associate, his lead researcher; Bob Kaplan. And he explained how these guys like venting to each other once in a while. It’s a productive element of their passion and intensity for fighting that epic battle of trying to challenge this flawed conventional wisdom that we’ve had about diet for so long.

I want you to go over and watch his amazing Ted Med talk. You can find that in the show notes or Google it. Where he kind of breaks down at the end. It was a very touching presentation. Half a million people have seen it. You got to add yourself to that list, where he apologizes in absentia to an old patient that he had to treat for diabetes, and he reveals to the Ted audience that he privately held this patient in contempt for undisciplined lifestyle habits. And proceeds to explain in the course of his presentation that we perhaps have the notion of diabetes, obesity, all wrong.

As Gary Taubes wrote in his book; Why We Get Fat, “Obesity and sloth are not causes of obesity, they’re are symptoms.” If you’re not following, I describe it further in the show notes and it’s really an important concept to understand.

So, he kind of got into this direction when he was an athlete over a decade ago, and was training for hours per day, every single day, training for his marathon, swimming efforts, and noticing that he was adding excess body fat and then came up, diagnosed as prediabetic despite this incredibly athletic lifestyle. And if you’re a physician and you have this mind bending eye-opening personal experience with disease diagnosis that you can’t even believe could be possible with all that exercise, but granted it was a carb addicted lifestyle pattern, because he was fueling these efforts with bombs of sugar. That sent him on the path to his life obsession, his calling now, where he’s trying to attack disease, the epidemic disease patterns from the cause rather than a flawed and dated conventional wisdom understanding of the calories in calories out model. Or that if you’re overweight, you need to stop eating so much and get your lazy ass off the couch.

It’s literally being proven untrue very quickly by the leaders in the field like Peter. So, we go off on a rambling road on this show as promised to the Get Over Yourself Podcast mission. You’re going to hear him talk about some stuff that might not come out on as many other shows that you can find on the internet, and all the great work that he’s doing on The Drive Podcast.

So, we get that tangent of the road rage idiots. We talk about his important concept of insulin area under the curve as perhaps his favorite longevity marker. We even get into the science and the genetics of peak athletic performance. Little cameos for Michael Phelps, Usain Bolt, Tour de France Champ – Chris Froome. And then we’ll have that imperceptible detour near the finish because my wonderful audio engineer, Brian, will fix that and patch in the new conclusion after I’m up off the couch. Maybe he will mess with me a little bit and play some of that recording.

“I’m feeling really dizzy right now.”

Fun times with Dr. Peter Attia. I hope you enjoy the show. Sorry for the lengthy introduction, but Peter [Warren 00:07:37] said, I want you to understand where this guy’s coming from and really enjoy it to the fullest. Thank you. Here we go.

Peter, thanks for having me. You’re pumped up, I can tell and I like that about you, man. You got to go hard in life, huh?

Peter Attia: I think so.

Brad Kearns: So, tell me about this Drive, it’s so exciting. You started a podcast.

Peter Attia: Yup, started it as far as recording, about two months ago and the-

Brad Kearns: The summer of ‘18 here.

Peter Attia: Yeah.

Brad Kearns: The year of the podcast.

Peter Attia: Right, right.

Brad Kearns: The year of the new podcast.

Peter Attia: Oh yeah, I’m sure. The world needs another one, I’m guessing. Yeah, so it will be a six-month experiment. So, they’ll run from July to December, and then we’ll make a decision about whether it’s worth doing.

Brad Kearns: That’s what Tim Ferriss said after his first five shows. His famous experiment, right?

Peter Attia: Hm-hmm (affirmative). That worked out well.

Brad Kearns: What’s your ambition for it? I mean, you got a story to tell, we know that.

Peter Attia: Yeah. I mean, I think everybody has a story to tell. That’s probably not reason enough. I think for me, I mean, it’s very clearly a number of things. But the most important is it’s got to be able to generate revenue to offset the cost of some of the research we do, which is kind of the most interesting part of my job; is trying to do this stuff.

I think for the last three years, we’ve been basically siphoning revenue off the patient side, which is like sort of what you do for a living, is take care of patients. But we keep siphoning revenue off of that stream to fund knowledge. And I think the internal appetite for knowledge just keeps going up but faster than I would want to be taking more patients in the practice.

Also, I always think that taking from your left hand to give to your right hand is not a long-term solution. So, I’m trying to figure out could you produce revenue out of a podcast that then is in service of kind of the knowledge creation we want to do.

Brad Kearns: Yes, if you want to donate to Peter’s podcasts, go to Peter Attia MD and you’re in.

Peter Attia: No, we don’t have anything set up yet.

Brad Kearns: The Patreon, the $10 a month. It’s a cup of coffee.

Peter Attia: We haven’t figured out if that makes sense yet actually. And I’m not in a rush to figure that out, because there are some people who have done it really well through Patreon or through other donation services and obviously the tried and true way to do it is through ads. But each of those has huge issues. So, we just don’t know which one’s going to be right for us and for the people who listen to our podcast.

Brad Kearns: So, tell me about this research team. You have quite a few people digging in and evaluating all the stuff that’s hitting them every day. How does that work?

Peter Attia: Yeah, so Bob Kaplan, who’s the head of that is the guy that I was just arguing with on the phone. So, you got a sense of like how passionate like I mean, but that’s Bob.

Brad Kearns: I wasn’t sure I was at your house and then I was on the road up 80 meters down and I heard your voice. So, I was like, “Okay, I’m here.”

Peter Attia: You’d hear me and Bob going at it. But that’s sort of like, that’s the way it is, right? It’s like we were arguing about something very passionately and it’s like, “No, this is complete bullshit. And no, no, no, this is the way it’s got to be. Blah, blah, blah,” and we go back and forth.

So, over time we’ve just been growing that analytical team and in part, working on projects that we deem internally interesting and relevant for our own knowledge that eventually becomes relevant to the patients. And sometimes, probably a quarter or a third of the time, it’s patients ask us questions that we don’t know the answers to and we think, “Huh, we really should know that.”

Like, just yesterday, a patient asked me about a supplement that apparently reduces homocysteine when methylated B vitamins don’t. And so, I was like, “Great, I’ve actually never even heard of this thing.” So, maybe it’s nonsense. It probably is nonsense, but we should know.

Brad Kearns: Right, right. So, the practice, tell me about that. You’re splitting your time between here and San Diego, and New York and you’re taking care of this like concierge service for patients interested in your particular approach.

Peter Attia: So, it’s not a concierge practice. Because concierge practices focus on access and the availability and stuff like that. Concierge is sort of a service that fits within primary care. This is not that at all. I’m not a primary care physician, I don’t displace the patient’s primary care physician. The practice is basically a way to help implement a model that we have into a patient’s own framework of their incoming health status, their genetic and epigenetic predispositions, and their own appetite for risk or their desires for lifespan and health span.

Brad Kearns: So, how does it differ from going to your primary care doctor or going to your GI specialist if you have an issue or going through the traditional medical environment?

Peter Attia: I mean, it differs so greatly that we would take the next hour to try to explain that.

Brad Kearns: So, you’re working with a small number of people.

Peter Attia: Yeah, I mean, maybe conceptually the biggest differences is that it’s proactive, right? Most of the medical system is kind of reactive. You go to that GI person, most of the time when something’s wrong. Occasionally you go there for a reason that is proactive. Like if you’re having a screening colonoscopy or something, that would be you showing up for something proactive. But for the most part, people are going to their doctors to address issues. And of course, the question is twofold; what can you do if you don’t have to wait until there’s an issue there or if you can see earlier warning signs.

But more importantly, I think it’s how do you take a strategy that we have, a framework maybe is a better way to describe it for longevity and then apply that to an individual.

Brad Kearns: Right, so, I love you talking about the big three diseases that you want to avoid and how to do it and you call it low-hanging fruit or the non-sexy approach of just getting the crap out of your diet. Can we cover those for the basic listener?

I think the niche I’m going for here is like, here’s my buddies that I grew up with, right? We’re all over 50 now. We still think we’re jocks. We’re trying to stay healthy and not just wind things down. But there’s that super enthusiast that’s signed up with you or willing to do the implant into the abdomen to look at your glucose or go keto and strictly adhere to this crazy diet. But I think there’s a big group of people they’ll do what you say, they’ll do what you suggest if it’s reasonable. They don’t need to know the intense scientific rationale. But how do we lay that out for … What are we trying to avoid mostly and how to do it?

Peter Attia: So, I want to make sure I understand your question. Are you saying what are the disease states we’re trying to avoid or what are the things that one does to try to delay the onset of those diseases?

Brad Kearns: Yeah, you’re talking about heart disease, cancer, neurodegenerative disease, right?

Peter Attia: Yeah, and I wouldn’t argue that those are low-hanging fruit. But maybe I’m misunderstood what you were saying.

Brad Kearns: Yeah, the approach. Those are the things that are killing most of western citizens, right? What did we just grab? They’re 75% or some crazy number.

Peter Attia: Mm-hmm (Affirmative). So, I think there’s almost no way that you wouldn’t as an individual improve your health if you … I mean, again, I’m speaking very broad, in general terms. If you didn’t sort of improve nutrition, exercise, sleep. Those three things would probably have the biggest impact on your physical health. And it’s hard to say that somebody who’s achieving 80% of their potential on each of those three, isn’t also achieving about 80% of their longevity potential.

Now, the difference between the 80% and 100% in terms of effort, is significant. It is not a nonlinear effort curve. Nor is it a linear curve of achieving a benefit. But a lot of this stuff you don’t need a doctor for. I mean, sometimes the doctor is helpful to measure things, but for the most part, I think there’s enough information out there for people to have a sense of what they should and shouldn’t eat.

I think people tend to get confused about things that don’t matter. So, there’s such an amazing … I’m sure you’re more familiar with this than me, but I try to not think about this stuff, but, endless confusion about, “Oh my gosh, should I be eating a plant-based diet or should I be eating a paleo diet or should I be on a low carb diet? Or should I be under this diet or that diet?”

I mean, we could talk about those things all-day long, but it might be more interesting to look at what do all of those things have in common, if they’re being done correctly. And that’s probably the element that one ought to think most about. So, as silly as it sounds, just to say like, “What if I had a zero-junk food diet or a diet of don’t eat anything that my great grandmother couldn’t have eaten?” I mean, something as simple as that.

Brad Kearns: Number one bestseller right there.

Peter Attia: Yeah, not the book I’d write. But something as simple as that would basically take virtually all sugar, refined carbohydrates, processed hydrogenated oils, and all the other bullshit that’s highly permeant within our food system and just take it away, done. And then yeah, you could vacillate on whether you should have grass-fed beef or non-grass-fed beef or no beef at all, or this type of egg or that type of egg or dairy or no dairy. I mean, those things are important to be sure. But they also probably on some level have different individual outcomes.

But if you got rid of sugar, if you got rid of refined carbohydrates, if you got rid of hydrogenated oils, and the products that they show up in, because you don’t buy those things off the shelf, right? It’s not like, “I want some sugar. Let me go to the shelf and get it.” No, it’s get rid of everything that those things exist in.

And again, this has been codified for decades. Like this isn’t like some new insight. The insight is the importance of this. I think the insight is if you do this for long enough, it matters.

Brad Kearns: Yeah, I get the comment. When I’m going off and people are teeing me up at a gathering or something and I’m giving my pitch about healthy eating and the ancestral movement, you get the comeback, “Hey, everything in moderation, and what about that?” And I kind of recoil at that because I feel like our offerings are so disastrously extremely unhealthy that that moderation approach is probably going to get you into a hospital bracelet at some point.

Peter Attia: Well, I mean, I think it depends on what we’re talking about. I’m personally not a huge fan of moderation, but obviously there are some things where I think moderation matters. So, there is truth to it, but you have to put it in context. Is smoking in moderation good or bad? Well, it depends what you’re comparing it to. Smoking in moderation is significantly better than smoking in excess. But smoking in moderation is not better than not smoking.

Now with smoking, it’s probably more direct, the relationship between the behavior and the outcome, the disease. There are fewer buffers in the system. So, I don’t want to get too geeky on like the engineering description of capacitance, but with smoking, probably even smoking five or 10 cigarettes a day can be quite harmful over a long enough period of time.

Whereas eating five to 10 grams of sugar a day is probably not particularly harmful over a long period of time. So, you have dose compression on the cigarette and you don’t have that same dose compression in food. But I think the principle still applies. The only reason to embrace moderation within nutrition when it comes to the bad actors, is if it’s the only way that you can maintain sanity. But from a health perspective, that doesn’t make any sense.

In other words, from a purely biochemical perspective, it’s irrelevant or it’s illogical to say that an approach of moderation is the ideal approach. No, if you’re talking about this purely unemotionally and biochemically, it’s consume the absolute best nutrition every minute of every day that you can consume. In other words, there’s no benefit to diluting it. It’s like saying, “Well, having a couple of drinks a day is okay.” No, it’s important to say, “Having a couple of drinks a day for most people is probably not outright unbelievably harmful, but it’s by no means adding value physiologically.”

Brad Kearns: Right. So, I suppose if we just take that basic step and cut out the processed foods, we’re going to hit that 80% figure that you’re talking about?

Peter Attia: I think for most people, yes. It also depends on where you’re starting from. So, that is not necessarily sufficient for somebody who’s already quite far down the line. So, people who, for example, have type 2 diabetes or people who have non-alcoholic fatty liver disease, which are two conditions that are more prevalent than people realize, and even more prevalent than probably the CDC realizes. For those people, I’m not convinced that an 80/20 approach is a great starting point. It might be a great long-term point, but they probably need to be a little bit more dramatic, especially with type 2 diabetes.

With NAFLD, probably just as strict attention to fructose elimination, even without carbohydrate elimination is probably going to produce the best outcome. But with type 2 diabetes, you really do need to deplete the body of glycogen. Until the body gets drained of 50% of its glycogen consistently which is … the easiest way to do that is through exercise and a significant restriction of carbohydrates. It’s very hard to begin to reverse the insulin resistance.

Brad Kearns: So, depleting your full max out glycogen stores all the time. We, athletes have been told in the endurance scene, you do your workout and you replenish glycogen because you want to have those tanks full at all times, especially before the race. So, are you saying, I’ve always wondered this, like if you go keto and you lose 12 pounds in the first eight days, that’s water retention and depleting your glycogen, and are you going to exist in a state where your stores are not full because you’ve restricted carbs so much? Or your, on the other example, you’re training all the time.

Peter Attia: Well, first of all, I don’t think anybody ever depletes glycogen stores fully. That’s a bit of a misnomer. So, even somebody-

Brad Kearns: Oh yeah, Tim Noakes said that. You think you hit the wall, but you didn’t hit the wall. You have whatever leftover as the central governor theory when you’re running the marathon.

Peter Attia: Yeah, you can take somebody who think that they’ve hit the wall and you can inject them with glycogen and you’ll get a huge spike of glucose. So, you never run out of glucose.

The question is really, I mean, when it comes to carbohydrate restriction and glycogen, it’s a question of how much do you need to dip into that. So, as an overly crude example, it’s like, are you better off having a gas tank that has 100 gallons in it for which you need to draw two gallons per minute, or are you better off having a gas tank that can only hold 50 gallons for which you only need to draw for the same output, 0.5 gallons per minute?

I’ll do the math for the listener. You will get twice as far in the second scenario, though the tank is only half as full. And the reason that in the case of the second tank in this analogy, of course, the gasoline or the fuel represents the glycogen. In the second case, it’s presumably because you’re able to access a different fuel store, fatty acid at a much higher rate than you were in the first case. And so, your energy needs are met using a fuel that you have a much larger storage capacity for.

Brad Kearns: So, we’re walking around with a half glycogen tank, then if you’re a long-term carbohydrate-

Peter Attia: Yeah, and it’s probably not even that. I mean, I think the research of Jeff Volek can Steve Phinney, who did biopsies, muscle biopsies on carbohydrate restricted athletes -it’s probably about two thirds. It’s probably a third depleted at steady state – all things equal. Again, I think the bigger issues that people have adapting to intense exercise during carbohydrate restriction, during initial forays into carbohydrate restriction has less to do with glycogen and more to do with managing the water and the electrolytes.

Brad Kearns: Oh wow. So, you’re low sodium because you changed your diet?

Peter Attia: Yeah, it’s the sodium, the magnesium and the plasma volume that’s probably the hardest part initially to adapt to.

Brad Kearns: I remember bombing out my first foray into ketosis after three weeks, and I blamed it on the extreme nature of the diet. And now, I’m coming to learn in my second successful route where I was pretty strict for five months, it was no problem. But getting those electrolytes and those background things handled is a big deal. And I suppose there is that competition for energy at the start that Phinney and Volek talk about where you need to ramp up your fat adaptation and your muscles are going for energy and your brain, and then you’re going to have afternoon blues and a subpar workout.

Peter Attia: Yeah, and for me also, just difficult sleep, initially.

Brad Kearns: Really?

Peter Attia: Yeah. I mean, if anything, it’s motivation to not go in and out of it too much because the coming back into it … like this week is my first week back in ketosis for years actually. And I’ve had some really pretty not impressive workouts.

Brad Kearns: So, you did that three-year stint, that crazy strict stint where you had the glucose meter and we’re monitoring all the blood levels without interruption for a long period of time, then you kind of transitioned out of that. I heard you say that your life got too busy, it was one of the main factors. You just kind of got sick of the regimentation or it wasn’t sustainable because of all your travel or something.

Peter Attia: Well, and also, I think just I wanted to … it’s a slippery slope, right? Mostly when I left ketosis it was that I wanted to eat more stir fry and more vegetables and things like that. It wasn’t that I was sort of wanting to go back to bread and rice and potatoes or sugary stuff.

Brad Kearns: Are you saying that it necessitates you – watching your vegetable portions as well due to your blood values? Are you asserting that?

Peter Attia: Yeah, certainly, I could not eat my sort of favorite curry stir fry and stay in ketosis. But again, you have to understand, I eat silly amounts of food. So, yeah, I could easily eat 200 grams worth of carbohydrate in a big stir fry, and certainly a lot of that is soluble and insoluble fiber, which probably doesn’t negatively impact ketosis. But there’s enough glucose in the volumes that I was wanting to eat, but that was going to take me out of ketosis.

Then of course, once I started entering fasting, that became a way to more easily allow me to tolerate other straight up carbohydrates, starchy carbohydrates quite easily. Because at least, for me, eating them in a very narrow window and being thoughtful about when I ate them seem to not have terrible effects on me.

Brad Kearns: Is this a once a day window where you’re waiting to eat any measurable carbs until dinner or something?

Peter Attia: It depends. It can be a once a day or twice a day.

Brad Kearns: But those fasting periods helped adapt you to bigger doses of carbs.

Peter Attia: It would seem so.

Brad Kearns: Okay, so, you span out of that after three years, concluded, got a lot of data and then went into what, more … what would you call it? An ancestral-aligned dietary pattern where your carb intake is still comparatively low to the average Joe?

Peter Attia: Again, I don’t really know about the average Joe. I sort of always benchmark back to what I would have been doing 10 years ago. But, so, yeah, I’ve never returned to those levels of carbohydrate consumption nor those types of carbohydrates. There are no liquid carbohydrates in my world, so I’m not drinking Gatorade and things like that. So, regardless of what kind of exercise I’d be doing, it would be branch chain amino acids or water. And if I needed glucose in liquid form, it would be super starch or something which is much more of a complicated molecule. So yeah, I was never back to that sort of way that I used to do things.

There was also certainly much more frequent … I hate the term, but call it cheat day, cheat meal or whatever. I mean, I was much more liberal with … It used to be that maybe once a year, I would deviate and then it became once a month and once a week. And again, for some people, that’s a valuable tool to have in the tool kit, because it just makes it more tolerable.

I think for me, it’s not such a helpful tool because I work well in absolutes. I mean one thing this week that’s actually been really fun, as much as it’s tough – readapting to ketosis. I actually quite appreciate the rigor and just the binary nature of it. It’s very clear what I can and can’t eat.

I opened the fridge I don’t know, half an hour before you got here and like pretty much I wanted to make some eggs. I finished a workout and I wanted to make some eggs and there were no eggs, and there was pretty much nothing in the fridge I could eat. I wasn’t going to eat all my kids’ leftover macaroni and cheese and their applesauce and all of the other things in the fridge that I pretty much-

Brad Kearns: Otherwise would enjoy I guess.

Peter Attia: Yeah, and if I wasn’t in ketosis, I think I would have convinced myself, “Hey, you just did a two-hour workout. You certainly could easily eat this macaroni and cheese and not have a blood glucose spike. It would go straight into your liver and your muscles. So, go for it, whatever.” But when I’m in ketosis, that’s a bridge too far.

So, in many ways, ketosis becomes indirectly valuable. So, I think directly, it’s valuable for a number of reasons. But I think indirectly, it’s valuable just for this sort of psychological and behavioral component for some individuals.

Brad Kearns: Probably a large percent of people have those temptations and that declining willpower because you’re exerting it too much on all kinds of different things. Like don’t get side-tracked on YouTube when you have to finish your emails. And now, the absolute part is … I think you’re onto something. Louise [inaudible 00:31:05] said the same thing. He said, people that are struggling to start out or struggling to adhere to ketosis, he tells them to eat the same exact thing every day for as long as it takes until you’re in that rhythm.

So, you have your two eggs with avocado and a dollop of mayonnaise and then you go onto your next … completely laid out and you know exactly what your macros are. So, it’s kind of a de-stress type of operation.

Peter Attia: And when I was in ketosis for those three years, the consistency amongst what I … I mean, I had a spreadsheet that listed everything I would eat. Every day was basically some combination or permutation of something I had already eaten and I knew exactly what the macros were of everything I was going to consume. So, it was modular and it basically took thinking out of it.

Brad Kearns: And were you doing that mainly for exploration, possible application to patients or seeing if you could get a performance edge?

Peter Attia: I think there were a number of reasons over those three years. Certainly within a few months, once I’d really … it took about three months the first time for me to really adapt aerobically. I mean, to have absolutely no deficits on exercise, even intense exercise. And then probably it took a year or a little over a year, maybe even a year and a half if I stop to think about it; to get even that anaerobic kick back that I’d kind of given up a bit. I mean, I think for me it was a great state. I just mentally felt great and you didn’t really have this dysregulation of appetite. Yeah, it was worth the pain. The inconvenience maybe is a better word.

Brad Kearns: Right, the inconvenience. So, did you get up and over your previous fitness level by virtue of having a better fat burning engine or anything of that nature? I mean, you said you struggled for the first month. You struggle for a year with the high power.

Peter Attia: I did, but there is a confounder, which is the training had also changed.

Brad Kearns: Dang! Then we can’t use your thing for an exact experiment.

Peter Attia: No, no, definitely not. As any athlete knows, your training is constantly evolving. So, I think it’s hard to … it would be odd if my training wasn’t evolving over a three-year period of time, and it was evolving. And I’d like to believe it was getting better and so, it could be that my performance was getting better because my training was getting better, and my nutrition was getting better. But I don’t know how much to attribute to each.

Brad Kearns: Sure, okay. Well, one thing that’s been sort of on my mind is this seemingly juxtaposition of the message that metabolic flexibility and getting that efficiency to survive and thrive on, a few calories is necessary. And you talked about this insulin area under the curve concept, where the optimally minimal amount of insulin you produce over a lifetime is going to be predictive of longevity. That was one of your favorite markers, if it were theoretically able to measure. And then on the other side, and this is Dr. Tommy Wood – Nourish Balance Thrive.

I’m doing his program and he looks at my thing and he’s like, “Okay, here’s a guy who’s over 50. He’s still trying to do crazy, magnificent athletic feats, break the world record, sprint, and lift heavy weights, do all that stuff.” My blood looks good, my body fat looks good. And he advocated for consuming like the maximum amount of nutritious calories in order to fuel my body with more nutrient-dense foods and more levels of all the great stuff that’s in the good food. And so, those seem to be at opposites, but maybe you can help explain that.

Peter Attia: Remind me what the first one is. Again, I’m not sure-

Brad Kearns: The insulin area under the curve. The idea that when you’re metabolically flexible or you’re fat and keto-adapted, you can thrive on fewer calories over the rest of your lifetime. You can produce less insulin to get the job done.

Peter Attia: That’s sort of only finite, right? I mean, at some point assuming both people have the same degree of energy expenditure, both deliberate and non-deliberate, then they’re both going to need the same number of calories. The question is how many are coming from inside the body versus outside the body?

So, early in the stages of ketosis when a person is not in fat balance, when they are not weight stable, many people are losing weight and I don’t just mean the water weight – yeah, they can eat a lot less because they’re eating themselves. So, their exogenous requirement of calories goes down as their endogenous requirement goes up.

But once they reach a steady state, either their metabolic rate must slow to accommodate that or they’re going to have to start eating more if they’re no longer eating themselves as much. But remember, the AUC of insulin is not proportionate to the total calories you’re consuming, it’s more a function of the type of calories you’re consuming.

So, you could have a higher AUC on a high carbohydrate diet, than you would more calories on a low carbohydrate diet. So, in other words, I guess I don’t see the equivalence between those ideas.

Brad Kearns: So, for back to that longevity goal where we’re going to stand by that concept of producing a minimal amount of insulin to maintain a stable body weight recover from exercise. And is there any uncertainty there? Or we just kind of-

Peter Attia: Well, there’s uncertainty in everything.

Brad Kearns: Yeah, I like that about you, man. Dom D’Agostino said the same thing when I talked to him. He said, “Watch out for scientists who speak in absolutes because they’re probably crappy, but that those are the ones that get on TV.” That was his quote.

Peter Attia: Yeah, this is a model for which we can’t actually test it in humans. So, instead, we rely on a lot of proxies which are, how much of this can be tested in animals? How much of this can be tested in softer outcomes in humans, meaning not the ultimate outcome, which is lifespan, but disease-based outcomes? And then of course, mechanistically does it make sense?

I think that it might be the case that you could still minimize lifetime AUC while still cycling periods of anabolism and catabolism. And that is kind of my latest thinking on this topic. Is that you might actually produce the best outcome if you’re cycling periods of growth and autophagy.

Brad Kearns: Would you apply that to say your daily eating patterns?

Peter Attia: Not daily, but rather to … for me, the experiment I’m doing now, it’s a quarterly, so, 13-week program times four. So, you have four 13-week quarters in a year. And it’s a week of nutritional ketosis, a week of fasting, like water only. And then a week of nutritional ketosis and then 10 weeks of time restricted feeding, and then you repeat it. So, that’s my current hypothesis. And the time restricted feeding for me … again, this is not a program I’m advocating for any other person on the planet, but this is just the way I’m going to do this until I get some data back, and I can adjust it. But the time restricted feeding will then also be a function of the type of exercise I’m doing.

So, on Mondays, Wednesdays and Fridays when I’m lifting weights, the feeding window will be wider to accommodate a more anabolic need on those days. So, I would probably do a 10-hour feeding window on Monday, Wednesday, Friday versus an eight or six-hour feeding window, Saturday, Sunday, Tuesday, Thursday. Which are days when I’m doing aerobic and anaerobic non-strength training.

Brad Kearns: So, you feel you have less need for fuel when you’re doing the aerobic stuff?

Peter Attia: No, I don’t feel like I have less need for fuel. I feel like I have less potential to tear down muscle. And so, on the Monday, Wednesday, Friday, I want to keep the caloric intake closer to the destruction of the muscle, which is happening earlier in the day for me. In an ideal world, I would exercise before opening the feeding window. But from a practical standpoint, that’s not possible. Meaning, I can’t work out at 4:00 PM and then eat dinner.

Brad Kearns: Just because of your schedule.

Peter Attia: Yeah, I have a job.

Brad Kearns: Yeah. So, why is that the ideal?

Peter Attia: Because I would like to be most insulin-sensitive going into the largest meal. And we are naturally most insulin-sensitive in the morning. And so, to exercise in the morning and then eat right after is theoretically great if you could trail off your calories by the end of the day. But socially and practically, that’s very hard to do. We, as a culture, for most of us, dinner is the important meal. And also, just the way we’ve structured our days for most people, it’s difficult to work out at 4 or 5:00 PM. Especially, if you have responsibilities beyond yourself.

Brad Kearns: So back to that refrigerator sample of the kids’ applesauce and the mac and cheese. But you just finished a two-hour workout. So, that’s going to go right into … Dr. Cate Shanahan says that the glycogen suitcases are open, they’re going to accept the cargo and close and not going to bother that precious, moderation of insulin.

Peter Attia: Right, and again, if not for the fact that I was in ketosis, I would have certainly bent. I still would prefer to have something that’s not macaroni and cheese because that’s just categorically shit. So, I mean carbs come in all different shapes and sizes, and we ought to optimize around the better ones. But that again speaks to the psychology of the default food environment. We eat what’s there. So, rule number one is make sure you’ve always got good food around so that when you are hungry, when you finish that workout, you’re not having to do what I did today, which was to have nothing. In this case, the thing I wanted to eat, which was eggs, wasn’t there.

Brad Kearns: Now, what’s going to happen when you ate nothing? You’re jumping back into ketosis, you’re a metabolically fit individual to begin with. So, what’s your body doing now when you passed-

Peter Attia: Yeah, I’m probably just breaking down muscle right now as we sit here a little quicker than I would like to be, and I’ll go and find something to eat after. Again, from an energy requirement standpoint, I can certainly subside. I mean, I’ve got enough glucose and ketone floating around. But it’s just the nature of this type of workout that I did today is one where all things equal if I’m trying to minimize how much muscle mass I’m losing-

Brad Kearns: And maximize the benefits of the workout, I suppose?

Peter Attia: I mean, I guess it depends on … there are so many benefits you get from a workout. There are some that are probably independent of what you eat after, and there are some that are dependent on what you eat after.

Brad Kearns: Well, now you’re getting the autophagy benefits, right? If you deplete the cells during the workout and don’t consume food after, you’re-

Peter Attia: Yeah, I’m probably seeing more autophagy than had I not.

Brad Kearns: So, you’re kind of making a trade for if you go get the fuel after?

Peter Attia: Right, and so, next week to not eat for a whole week, that’s hugely optimized around autophagy. Everything else pays a price. I will shed … I don’t know, we’re going to find out. I’ve been weighing myself every day since I’ve been back in ketosis. I’m probably four and a half pounds lighter than I was a week ago. Again, a lot of that’s going to be water weight.

Brad Kearns: And glycogen?

Peter Attia: Well, but every gram of glycogen has four grams of water.

Brad Kearns: So, you’re calling it water weight?

Peter Attia: I’m calling it mostly water weight. So, yeah, I’ve lost a little bit of glycogen-

Brad Kearns: Half-tank status.

Peter Attia: Yeah, maybe I’m half to two thirds tank, but it’s the water that left. That is the bigger issue. Plus, the plasma volume, independent of the intramuscular and intrahepatic water in the glycogen.

So, next week I’ll probably lose six, seven pounds. I wouldn’t be surprised. And some of that will certainly be lean tissue.

Brad Kearns: And fat I suppose.

Peter Attia: Yeah.

Brad Kearns: And then you’re going to ramp it back up the next week and probably put some of that weight back on just from consuming more food.

Peter Attia: I’d suspect, yeah. And that’s why I kind of wanted to sandwich the fast around two keto weeks. The first one makes it easier to get in. The second one makes it easier to not go off the rails when you come out.

Brad Kearns: Really? Why is that?

Peter Attia: Well, because I think truthfully like I’m going to be breaking the fast on a Saturday.

Brad Kearns: You know this is a keto week, it’s not a crazy pizza-day week.

Peter Attia: Yeah, exactly. Because I know that the first meal I’m going to have is going to be at the airport at JFK.

Brad Kearns: Sbarro or what’s the place called?

Peter Attia: Yeah, if I were and all bets are off, you just fasted for a week, you can do anything you want, I’m pretty sure I would eat more food in that two hours, then you can imagine, and it would be pretty bad food. But by knowing that I’m back into keto, I’m going to have very limited options for what I can have.

Brad Kearns: So, you’re speaking to this psychological strategy of putting these barriers and expectations up for yourself. Otherwise, you’re going to go off the rails. Do you think that’s a common theme among modern citizens here? And we could benefit from throwing more regimentation into it? Is there a downside to that? Does it depend on the person?

Peter Attia: I think it depends on the person. I don’t know.

Brad Kearns: And so, you’re this like extreme character who likes to swim to Catalina and so forth, and also maybe go off the rails more so than the next person who might have a nice salad after a week of fasting or something.

Peter Attia: Yeah, I’m definitely not that guy. Everything I do, I do in excess.

Brad Kearns: Like the phone call?

Peter Attia: Yeah.

Brad Kearns: We should have recorded that. It was top-notch, man

Peter Attia: How many times do you think I said “fuck” on that call?

Brad Kearns: Well, more than the podcast right now, but we still got a while.

Peter Attia: If I didn’t stop swearing for the rest of the podcast, I wouldn’t be able to catch up with that. I was super fired up. Not at Bob, I wasn’t mad at Bob. I was mad at something else, but I was venting to Bob and Bob’s amazing because he lets me vent.

Brad Kearns: Now you do you let that flow? Do you have any sort of sensitivity to regulating that? You’re directing it I imagine in certain compartments in your life with no problem?

Peter Attia: Yeah, I do regulate it. And I realize like I’m getting better at it, but I’m so far from perfect. But there are places where … like I wouldn’t want my kids to see me doing that-

Brad Kearns: Or receive that, of course.

Peter Attia: Well, certainly not receive that. But I don’t even want them to see that, actually. Because they’re not probably old enough yet to understand the difference between someone who’s angry at something and angry at someone.

Brad Kearns: Yeah, or whether you were losing it, which you most clearly were not. You were forming a very logical and passionate argument in a regimented and focused manner. I mean, you can’t call that going off literally.

Peter Attia: Right, but I think for kids, that’s harder. And then also, I think there are times when I’m really angry when I realize that … everything that I said in that outburst I stand behind completely. Like, I am absolutely adamant that what we just talked about was relevant and important and that that was a discussion that had to be had, and the work that will come out of this is going to be important. But there are times when you can see you’re going to get angry at something that’s not relevant and doesn’t matter. So, those are areas where I’m more interested in regulating. So, for example-

Brad Kearns: Highway 5, coming down here, trying to be on time for my date with Peter.

Peter Attia: There you go.

Brad Kearns: What the F is this?

Peter Attia: That’s right. So, yesterday I drove up to Malibu and back. And I mean, I don’t know. I mean, I don’t even know how many hours I was in the car. And it’s always dumb, like when the traffic stops in the 405, and you realize why, which is like somebody in the other lane stopped and everybody had to stop and look, like that’s infuriating. But that to me, is not the stuff you want to go off on, right? That’s when you want to be reflective. That’s when you want to meditate. That’s when you sort of want to think back about David Foster Wallace. This is water, this is the experience. So, again, I don’t claim to be like a master of any of this stuff. I’m still experimenting with all of these things and realizing the joy of getting incredibly pissed off, and then taking a step back and looking at why.

Sometimes, I can’t do it, right? Sometimes, I just get really pissed off and that’s the end of it. But half the time, I can get really pissed off and go, “Oh, why are you really pissed off?” This is all in your mind. This is just an emotion that you’re experiencing, that’s negatively valanced, and it has to do with some perceived threat that now you should start to question those assumptions. Does this really matter? Will this matter in five minutes? Will this matter tomorrow?”

Brad Kearns: Is it worth the cost of let’s say having an altercation or what have you?

Peter Attia: Oh, and never mind that.

Brad Kearns: Just your own anger.

Peter Attia: Luckily, for most of us that’s such a rare occurrence. But yeah, it’s just like, “Is this worth the hypercortisolaemia that I’ll transiently develop?” And look, maybe by the end of this discussion, I’ll be like, “Oh, you know what? Why did I get so pissed when I was talking to Bob? I should have just called him and said all of that stuff without like venting to him about how pissed I was.”

Brad Kearns: That’s kind of maybe the beauty of your connection with a close co-worker. Is that you can unload because if the subject matter that you were complaining about called on the next line, you’d save the “F” word and you have a more reasonable discussion.

Peter Attia: Yeah.

Brad Kearns: Yeah. I recall being out there on the bike and doing the road bike thing, and I didn’t realize … I’d be chit chatting and spinning along and then if a car cut me off, I’d scream at them. For years, I was in that hyper alert state where I was infuriated that anyone dare risk my life. How dare they use their 2,000-pound vehicle to try to knock me off my little 18-millimetre wheels. But, you don’t realize it until it comes out of you, I guess.

Peter Attia: Yeah, and I share that when I used to be a quasi-serious cyclist that was spending so much time on there. And then once I had a friend that died who was killed by a motorist, I took it to a new level. It actually got to the point where my friends thought I was going crazy, but I wanted to carry a rifle in my backpack. Like, how we have those pockets in the back of our jerseys? I wanted a rifle in one of those that like, I strapped around my-

Brad Kearns: Put on the top tube, maybe a little mounting thing?

Peter Attia: Yeah, and I was like trying to figure out if that’s legal in California. Can you have a sawed-off shotgun on your bike? And I was like, “The next driver that mindlessly cuts me off is going to lose his rear tire. End of story.” I don’t care if they veer off the road and die, good. Get them out of the gene pool. They’re done. I mean, I was so pissed and one of my friends was so funny. I won’t even remember what he actually said when he was mocking me, but he basically came up with this character of me being wolverine. And like how I was just going to like slash any car that came-

Brad Kearns: Gripping the handle bars with your claws.

Peter Attia: And I don’t have a good answer for that. I mean, I still think cyclists are justified to get pissed off. I mean, if I were out there on a bike today, frequently, I’d probably carry a bunch of rocks in my pocket and make sure I pinged every car that drove by with a rock.

I don’t know, that’s probably not the answer. I mean, I don’t know what the answer is, but it’s definitely scary. I might go out on my bike once a week, and just last week was out with a buddy, and … I mean, and the thing that really pisses – one thing when they aren’t paying attention, and anybody can make that mistake. It’s another thing when they’re very deliberate and they’re trying to scare you. And this complete knucklehead in a pickup truck just … he had it out for us. We were descending on a hill where we had to make a left-hand turn. So, now we’re going about 55 miles an hour down this hill, but we are back off our saddles screeching on our brakes to try to get down to about 20 miles an hour, so we can make this turn. And he is behind us and he is speeding up.

I can tell he is speeding up and getting closer and closer and closer to us, with absolutely no effort. And by the way, he wasn’t turning. So, we’re already veered off to the left to make the turn, he’s coming over behind us – I know he’s not planning to turn because I can … I found out after, he just wanted to scare us and then go straight. And my buddy and I who were out there … and he’s a very experienced cyclist. He did RAAM twice, so this is a guy who – he’s been on a bike a lot.

Brad Kearns: It’s a race across America, a 3000-mile nonstop bike race. Requires some experience.

Peter Attia: But unlike previous, neither of us said a word after until we got through the turn and then we looked at each other and we just kind of went, “What a dick?” Like at about that decibel level and then just kept riding.

I don’t know, some days you get pissed, some days you just shake your head. If that dude in the pickup truck, dude, if you’re listening to this right now, I want to tell you something, you’re a fucking asshole.

Brad Kearns: For real.

Peter Attia: Yeah man. Fuck you.

Brad Kearns: I know you’re having a bad day out there, obviously, any one doing that-

Peter Attia: No, you’re a dick. No, no, you’re a total dick. And you know what it is? You’re just jealous that you’re a fucking piece of shit in your pickup truck and these two guys are out in spandex, and if that hurts your feelings, too bad. Go to therapy, get it checked out. But don’t ever come after us again. You piece of shit.

Brad Kearns: Yeah. I mean, my solution is I basically stopped riding just because if I’m making a spreadsheet of the top 20 most dangerous things I do in my life, number one is road cycling. I don’t know anything that’s close-

Peter Attia: I agree.

Brad Kearns: … to say number two, three, four, five, six or seven. Driving a car, I mean, we all accept that risk of getting in an airplane. They had a crash-

Peter Attia: Yeah, the margin of safety on the bike is so low and my brother who’s also transit, he had a very bad accident on his road bike that was the fault of a runner. So, he was going 25 miles an hour, zipping down a road. I mean, if he could be faulted for anything, it’s that he was probably only two feet off the parked cars that line the road. But, okay. So, meaning he should have been thinking, “Hey, some idiot could open their door here or whatever.” But a runner decided somehow to just run across the street and didn’t look. And they hit each other head to head. Literally his head and her head hit.

She fractured her skull. He by far got the better end of it. She was in much worse shape, but I mean he’s still (this was three years ago) not back to normal, completely. He still has concussive symptoms. But now he mostly just rides mountain bike every day because his view is, “Look, yeah, you fall more on a mountain bike for sure, but any mistake, any accident is your fault.”

Brad Kearns: Oh, and it’s you’re not going to die most likely. My worst crash-

Peter Attia: You’ll break a wrist, you’ll break a collarbone. These things are horrible. You’ll get bruised. One, it’s your fault and two, it’s not fatal. But yeah, I had a very close friend who died on a bike, but then I’ve known of cyclists, guys that were in your group that you might not have known well. In San Diego, there’s like one a month, it seems. So, I agree. When I used to ride my bike down to La Jolla Cove when I was a swimmer, and do my long swims and everybody would say, “Geez, you must be so afraid of the sharks.” And I was like, “Actually not at all. I’m afraid of the goddamn bike ride to La Jolla Cove. That is way scarier than the four hours I’ll spend in the shark-infested Pacific Ocean.”

Brad Kearns: So, you’re doing a four-hour swim in La Jolla Cove?

Peter Attia: Oh, not now. This is back when I was a-

Brad Kearns: I mean when you were preparing for Catalina?

Peter Attia: Yeah, five-hour was sort of my go-to swim down there, which would be a … it’s a 10-mile swim. There’s a nice 10-mile route you could do in the cove.

Brad Kearns: Are you hitting the shore every two and a half miles?

Peter Attia: Yeah, you go a cove to shore, back, cove to peer, back, cove to shore, back, cove to peer, back -it’s 10 miles.

Brad Kearns: And you’re getting water when you’re getting up to get a drink? Do you need some nutrition after 10 miles? I mean, that’s very-

Peter Attia: So, back in the day when I was doing that before, I was obviously, knowing what I know today about nutrition, my main source of nutrition was something called Hammer Strength. You know of Hammer Perpetuum? You probably use this stuff too.

Brad Kearns: Sure. Oh yeah, I used to sell it.

Peter Attia: Yeah. So, I was a Hammer Perpetuum guy, was my go-to. And I still think of all the high carb stuff out there, it’s probably the least bad. It comes with so much protein and fat that it actually has a nice absorption pattern. But for a 10-miler, what I would do is I would have two bottles of perpetuum on the shore, and I would-

Brad Kearns: Hopefully, when you get there.

Peter Attia: I was lucky, I never lost a bottle. I would kind of bury them in a place that I knew where I could get to them high enough back on the beach. And then I would carry one. Like I’ve got a speedo one and then you wear … you know what a drag suit is?

Brad Kearns: Sure.

Peter Attia: Yeah, so I put a drag suit on top and then you stick a bottle in the crack of your ass between-

Brad Kearns: Oh, my goodness, that’s going to slow you down, big time.

Peter Attia: It does, but that’s part of the drill. You’re getting the resistance.

Brad Kearns: Oh, so you don’t mind the resistance?

Peter Attia: Well, it’s a training swim. You want the resistance. That’s why you’re wearing the drag suit. And then yeah, by putting the … we called it the ass crack drink in there, that would just generate like a parachute off your bathing suit.

Brad Kearns: For sure, for sure. I guess you needed it. It wasn’t just for kicks to slow down, but you needed that drink each hour of your swim.

Peter Attia: Yeah. So, basically two on the beach and one in your butt was sort of the routine.

Brad Kearns: That’s a quote for the show right there. Two on the beach and one in your butt. Nutritional advice for swimming La Jolla Cove. And if you see a floating little container of perpetuum out there, return it please.

Peter Attia: Or if all you see is the floating perpetuum, there might be a swimmer attached to it that you just can’t see because you know.

Brad Kearns: Now, they have shark sightings out there frequently, right?

Peter Attia: They do. There is no question there are Great Whites out there. There are tons of Great Whites in Coronado. I mean, I used to talk to the fishermen all the time because those guys are the ones out there seeing it. And they were like, “Oh yeah, like once a week we see at least a 12-footer out here.” And I’d be lying if I said there weren’t days when that got in your head. Especially, like I remember when that swimmer got killed in Solana Beach, which was a beach I used to always swim at. I mean, I guess you sort of think like, “is this the day?” And I think the scariest part with the Great Whites is the attacks are so often fatal.

Again, not to lay blame or no blame, but the sharks aren’t trying to attack a human, they think we’re prey. And so, the whole thing’s a bit tragic because they’re not even getting the meal that they set out for.

Brad Kearns: Oh no, they’re not happy with that meal?

Peter Attia: No, not at all.

Brad Kearns: They need something else? They need a seal?

Peter Attia: Yeah, they need much more fat.

Brad Kearns: Okay. Unless you got a really fat swimmer, I guess, which can happen when you’re addicted to carbs, right? What did you lose? Like 40 pounds from your peak?

Peter Attia: Yeah.

Brad Kearns: But when you were 40 pounds more, you were a high-performing endurance athlete, right?

Peter Attia: Yes, although I think it’s very important to put that in context. First of all, I don’t think I’ve ever been a high-performance athlete in anything in my life. When you think-

Brad Kearns: If you made it to shore from Catalina to San Pedro, I would say that that’s a high-five at a minimum.

Peter Attia: It’s all relative. I mean, I think that’s more a feat of, sort of stamina and mental toughness than it is … I mean, to me, the people who are setting the records doing that, who are crossing the Catalina Channel in eight hours, these are people who are … that’s super high performance.

Brad Kearns: It’s three miles an hour or something. It’s flying.

Peter Attia: Yeah, it’s a little less. It’s about 2.6, 2.7 miles an hour, yeah. And again, generally speaking, the people who are setting these eight-hour times are both the best swimmers and they get the right day. And the right day means you generally get a little push off the islands. You got a little bit of a tail current, but your ground speed would still be about two and a half knots. Maybe 2.3, 2.4 knots, which is staggering.

Brad Kearns: Yeah, go try that in one length of the pool if you’re a competent swimmer and see how fast that is. It’s like the marathon guy’s going, “Oh, 2:02, new record. Wow, that sounds fast.” And then you go to the running track-

Peter Attia: You realize that you have to run a 4:40 or something.

Brad Kearns: Yeah, you run a 71 on a 400-meter track and see how that feels and then imagine doing that from here to downtown San Diego or whatever your reference point is. It’s stunning. What is that, Peter? Is that like the genetics are-

Peter Attia: For the marathon runners?

Brad Kearns: And the person … who’s that? Susie Maroney that swam to Cuba in record time or these people that go off the charts with unheard of performances?

Peter Attia: I mean, yeah, that’s a whole interesting and separate discussion. I think there are people who are … it’s a right combination. It’s everything has to line up. So, if you talk about the marathon runners, I’m sure … I don’t know if you’ve ever seen the documentary Breaking2?

Brad Kearns: Mm-hmm (Negative).

Peter Attia: It’s a documentary about this … it’s kind of a Nikey stunt actually. It’s basically Nikey propaganda – which is fine because I like Nikey and I still have a Nikey shirt.

Brad Kearns: They orchestrated the sub-two-hour marathon attempt on the car racing track in perfect conditions.

Peter Attia: Yeah, that’s right. But, what I found interesting about it is it also is a great way for people who aren’t interested in marathon to at least … look, if you’re willing to spend 90 minutes watching this documentary, you’ll also get a sense of how special these guys are; the athletes and how built for purpose they are. Because if you really wanted to build the perfect runner, what would they look like? They would have an enormous cardiovascular and cardiopulmonary and cardio respiratory capacity.

So, they’d have these relatively large thoraxes. They’d have relatively large quads, glutes and hands, and then nothing else. From the knee down, they should be as small as possible, because you don’t want to have to carry that weight swinging back and forth like a pendulum. And obviously, the arms should be as small as possible. The waist, hips should be as small as possible.

So, their power to weight ratio should be very high. And then you want to introduce form. You want to know the people that can transmit the most of their weight, the most of their force directly into an upward motion. Because speed is by how high you go, not how far … I mean how far you go is a function of how high you go.

So, when you’re running long jumper, when you’re running down the thing, you’re trying to optimize how high you jump because the higher you get, the longer hang time you get to allow your translational horizontal velocity to get you far.

Brad Kearns: It’s the force into the ground. Like Usain Bolt generates 1,000 pounds of force with each stride. And that’s why he can go eight feet with a stride.

Peter Attia: Usain Bolt dry generates more downward force than any sprinter ever recorded. People say he is able to run so fast because his legs are longer than everybody else. That’s not true. It’s because of what you said, it’s because he hits the ground so hard that he gets more air time to make the leap between each step.

Brad Kearns: Yeah. Also, interesting about the turnover concept, there was a big article in Sports Illustrated years ago, where even the average casual middle school soccer player has the same turnover rate. Like they turn their legs over at 0.17, just like a world class sprinter. So, it’s all about the force off the ground, not the turnover.

Peter Attia: It’s total force mass. Absolutely. Ryan Flaherty, who I’ve talked about many times on different podcasts, and he’s a good friend, actually works at Nikey now. I mean, he and a couple of other really interesting guys – a guy that I don’t know, but I believe his name is Owen Anderson, who is actually probably the godfather of all this stuff. I mean, these guys have really kind of codified the science of speed. And again, that doesn’t just mean sprinting. That applies to the marathoner as well. It’s the same concept.

Brad Kearns: So, with the swimming-

Peter Attia: The swimming’s a bit harder. I think swimming is different. I think the best swimmers are not the ones that are doing the best force to mass. Because water and air obviously have this one subtle difference, which is density.

So, in running the speed is not really fast enough that aerodynamics matters that much. Now, that said, at the world’s elite level, it does. And that’s why in Breakin2, they had pacers. So, you absolutely want to have … in fact, I think they had like a car in front of them with a windshield. So, they were sort of going out of their way. But even a pacer will make a difference both from the-

Brad Kearns: A pace or breaking the wind for you behind.

Peter Attia: Correct, correct.

Brad Kearns: So, the key guy who’s trying to win is not-

Peter Attia: He’s never facing the wind. The faster you go, the more relevant that becomes. So, the next level up is cycling. How much does it matter? It matters a whole heck of a lot.

Brad Kearns: It’s the whole sport.

Peter Attia: And it certainly matters once you’re above 25 miles an hour. That seems to be mathematically about the cut-off in cycling.

So, if you’re an athlete listening to this who’s training for an Ironman and you really believe that you’re going to be able to average 21 or 22 miles an hour, which is a totally respectable speed for 112 miles, save yourself the money and don’t get a disc wheel. Because the disc wheel doesn’t … it comes at a higher cost than benefit at a speed of 22 miles an hour. Because the cost – because it does cost you wait and crosswind. It’s helping you when the wind is straight in front of you or straight behind you. But at 22 miles an hour, you’re not quite fast enough to get the aero savings front to back at the cost of the weight, which will punish you on every hill, and the crosswind where it will punish you.

Brad Kearns: You’re not going to get like a sailboat effect from a crosswind hitting your disc wheel? We always thought that, wondered that, I guess.

Peter Attia: Probably, not right? Because unlike the sailboat, you don’t have a rudder.

Brad Kearns: The sailboat’s actually going an angle.

Peter Attia: Exactly, the sailboat doesn’t jib. Like the sailboat jibs, the cyclist doesn’t. So, no, I think the crosswind is hurting you. But at a certain speed, so when you look at the world’s best, these are guys who are going to hold 24, 25, 26 miles an hour, maybe even more at 112 miles. Yeah, they’re getting the benefit of the disc wheel. And then of course, once you get into like time trailing for shorter distances where guys are going 30 miles an hour faster, then you’re going to always make a trade-off in favor of aero.

In fact, the aero position itself is a compromised position for power output. You’re occluding your femoral vessels. You are impeding venous return to the heart. My power output in an aero position was consistently 30 watts lower than when I was sitting up.

Brad Kearns: In a stationary setting-

Peter Attia: That’s right.

Brad Kearns: You can measure your watts. For those not super familiar with cycling, you can measure how much power you’re putting into the pedals. And so, when you sit up, you’re putting out more power.

Peter Attia: Absolutely. So, when we would do an FTP test sitting up, meaning climbing is the easiest way to do a power test. So, if you find a hill, it’s relatively … you find a 6% grade hill for a few miles and do 20 minutes sitting up, cranking for 20 minutes, you take that average wattage, you multiply it by about 0.9, that’s called your functional threshold power – directionally.

You do the same test on a flat with yourself in an aero position, you’ll be lucky if you could be within 30 watts of that, because of this compromise. So, the question is, if you’re doing a time trial, why would you still go into an aero position? Because despite the fact that you put out less power, the benefit on aerodynamics is so great. And then you go even further once you get into Formula One, aerodynamics is everything. It’s one of the single most important pieces of what enables those cars to go so fast.

And why, for example, you’ll see so much slingshotting, where a guy comes behind another guy and he can just generate so much more speed to go past that guy because he’s been in the slipstream of the car in front of him.

Okay, so why did I go off on that long thing?

Brad Kearns: Cause you like race driving I guess.

Peter Attia: That’s probably why.

Brad Kearns: Now, tell me about that. Are you a racer?

Peter Attia: Well, I want to go back to answer your swimming question. So, the swimming question is in swimming now, it’s a totally different equation. So, in swimming, density of the fluid, in this case water, not air. Air is a fluid. But in this case, the density of water is so much greater than the density of air that pretty much everything in swimming comes down to avoiding drag.

The best swimmers in the world are not necessarily the longest or the least fat or the most muscular or whatever, whatever. Probably the lowest correlation with VO2 max in swimming versus running and cycling. And even there, the correlation is not as high as people think, by the way. VO2 max is not as highly correlated as PVO2 max or VVO2 max. That’s what really predicts the winners. But in swimming, none of that stuff matters nearly as much, as can you put your body in the shape of a vessel that minimizes drag.

Brad Kearns: I think some of those people have those physical attributes that kick them over the top, like Michael Phelps with his double-jointed size, 14-flipper feet and the shoulders that were hyper flexible. But I feel like in general-

Peter Attia: I mean, those are two examples of things that both minimize drag, but also maximize thrust. For a swimmer that can straighten their ankles completely, yes, you basically have a kick that’s going to lead to a much more forward propulsive behavior. If you did an experiment, put yourself on a flutter board and put your ankles at 90 degrees. So, put no dorsiflexion into it or not plantar flection, sorry. And then you kicked, you’d actually go backwards. Like you have negative thrust at that point.

Brad Kearns: Like a backward paddle-wheel or something.

Peter Attia: Exactly. So, the difference between being at 90 degrees and 180 degrees is everything. And obviously, nobody’s going to be kicking at 90. But let’s say the average person’s kicking at 160 degrees, and there’s somebody that can kick at 175 degrees, that’s an enormous advantage.

Then the elbow and shoulder flexibility – and it’s really not shoulder, it’s actually scapular flexibility that allows you to keep the elbow as high as possible in the catch, so that you can hold the maximum amount of water on the vertical part of your arm. But again, thrust and drag avoidance are everything in swimming.

Brad Kearns: Then the other component which I sometimes feel is undervalued is the smart training, and not overtraining and getting the mind right so you can handle the pressure. And I think these in general, like let’s say the NCAA athletic arena where they take these distance runners that are great champions in high school or the age group swimming ranks are filled with kids that burnt out when they were 14 instead of 23 with gold medals around their neck. And so, that part’s a little disturbing because it’s sort of a survival of the fittest in terms of how much work you can survive without falling apart. Even if you did have the great scapula, and even the work ethic is sort of irrelevant if you keep getting sore throats because something’s going on with your system.

Peter Attia: And I almost separate those two. And I agree, they’re both as important. I mean, you, can’t get to the level of being the best if you don’t have independently, I think this mental toughness and then also the work ethic to sort of get it done when you don’t always want to.

The mental toughness amazes me. I mean, I’ve seen Phelps race so many times, and I think for those of us who like swimming, the fact that we could have been around during the Phelps era to have watched him … I used to go and like watch his practices in person as many times.

Brad Kearns: Oh really?

Peter Attia: Oh yeah, yeah, many times. But there was just an amazing generation of swimmers too. I mean, Lochte’s a guy who I think would be much more well known. I mean, he’s pretty well known both for his swimming exploits and non-swimming exploits. But I think most people don’t realize how good a swimmer Lochte was. It’s just he was in the shadow of the greatest swimmer of all time. It’s sort of like you probably would have never heard of Affirmed if he was around when Secretariat was around.

Brad Kearns: Phil Nicholson, your neighbor would be one of the greatest of all time, but he has a lot of second places and Tiger took that over. But yeah, I think Phelps and then seeing Usain Bolt do what he did and that consistency of coming back year after year is something that’s once in a lifetime. Same with Tiger Woods and that’s something to be appreciated. I think those are the greatest examples that we’ll see for many, many years performing at that highest level.

Peter Attia: I think it’s incredible. And again, because I don’t play golf, I probably have less of an appreciation for the greatness of Mickelson or one of these guys. But yeah, as a swimmer, I could go and watch Phelps do something and look at the … like you can geek out on the metrics, right? Like look at the stroke rate, look at the distance per stroke, look at the turnover, look at X, look Y, look at Z, and it’s like, wow.

Brad Kearns: Yeah, I swam with a guy in Sacramento named Jeff Float and he was the Olympic gold medalist in 1984, probably the most up-named swimmer of all time. And also, the first hearing impaired gold medalist in the proper Olympics. And he would get into the practice pool, 25-yard pool and his stroke count was nine strokes. And so, for reference, like a really good swimmer is getting to that wall and what, 14, 15, something like that. I was trying to go down from 18 to 17 and really work hard on extending-

Peter Attia: And most people who don’t know how to swim would be 25 strokes.

Brad Kearns: Yeah. So, he’s across the pool in nine strokes. And so, if you watch from the deck, it looks like he’s cruising. And I remember my first workout with him, I was kind of nervous. Here, I am standing with a gold medalist, “Hey man, can I jump in on your workout?” “Sure, sure. I’m going to warm up a little and then we’ll do some hundreds.” And so, I looked over in his lane and he was just warming up, and he kept warming up. Usually, you warmup, what? 500, 700 at the most. He kept warming up, kept warming up and I’m finally like, “Stop, like when are we going to start the bloody set?” And he was halfway through his hundreds, but his swim is so gentle. He’s not splashing water and he’s going at this relaxed stroke rate, and he was hitting double O, like a very fast hundred pace just with seemingly a warmup swim.

Peter Attia: Very often, the best at these things are also the most beautiful to watch. It’s not always the case. In cycling, I mean, I’ve always found Chris Froome a little awkward to look at. Like he doesn’t look graceful, but he’s heads and shoulders above everybody else. So, when it comes to putting out watts per kilo, Froome is going to do it better than anybody else even if it doesn’t look great.

But in swimming, the only example I can think of, of someone who really looked like they were struggling, but were still going faster than everybody else was Dolan. He won-

Brad Kearns: Tom Dolan, he was like a 50 guy.

Peter Attia: No, well, his real claim to fame was the 400 IM. He won two consecutive gold medals in the 400 IM. So, he won ‘96 and 2000, 400 IM. He was a Michigan guy. And I never knew him. I’ve never seen him swim except on video, but it’s like, oh my God, he just didn’t look like a fraction of the grace, but I mean he was a killer.

Brad Kearns: Doing something right under the water.

Peter Attia: Yeah, for sure.

Brad Kearns: So, I’m big on this kick of keeping athletic goals going throughout life and making them age-appropriate and lifestyle-appropriate. You had your day for doing your five-hour training swims and your attempts to cross the Channel. What are you doing these days or what do you envision as future goals to keep it balanced with all the busy work you’re doing?

Peter Attia: I got to tell you, I don’t really have many performance goals. I mean, my first goal is always to show up and do the workout. So, my first goal is completion, is called the attendance goal. So, don’t miss a workout ever.

Brad Kearns: Really, ever, huh?

Peter Attia: I mean, I’m going to … but that’s the goal. That’s the first order term, is make sure you hit every workout, even if you don’t feel like it. Even if you have to modify it a little bit. Like this week, I got on my Trainer to ride on Tuesday and I couldn’t believe how bad I felt. And I was like, “Okay, well you got two choices. You can just stop five minutes in or you can do it, but lower the power target.” Because I’m doing this thing on TrainerRoad, so it’s sort of spitting out numbers and you’re an Erg, that’s forcing you to generate a certain amount of power.

So, I just lowered it but yeah, still got through the workout. And today, even today, like it would have been incredibly convenient to have skipped the workout because there were just too many things that I had to get done. And I got home so late yesterday and I didn’t get up as early as I wanted to this morning and I was … 47 goddamn emails that needed to be responded to in 10 minutes, and blah, blah, blah, blah, blah.

Also, I didn’t feel great. The keto thing still feels really pretty … I don’t feel great. But I was like, “Look, you got to go and you got to do it.” And then even my first exercise after my … I have a very long warm up. Actually, on a day, like today I spend … once a week, I do a very long, like I do an hour to 90-minute warmup. It’s sort of a physical therapy type warmup before I get into the heavy stuff. And today’s first thing out of the gate was back squats. And I just knew it just wasn’t feeling right. Somehow, the drive back and forth yesterday up to LA, I’m on my ass all day. Even while I’m up there, I’m sitting, I just felt my QLs were very tight.

I warm up with the bar, 95 pounds, 135 pounds, 175 pounds, 185 pounds, whatever. It didn’t feel good. I was like, “That’s it, we’re done.” But I didn’t can the workout. I just called an audible. I said okay, “We’re going to be split squats, curtsy squats, a whole bunch of much lighter things to do it.” So, really that’s my most important goal; is just show up, don’t get hurt.

Brad Kearns: It’s okay to call audibles.

Peter Attia: Yep. As far as performance goes, I’m actually pretty happy being a little bit back on the bike. I’m a little bummed at how unfit I am. I think it speaks to the specificity of what I used to do and what people used to … people do who take this sport seriously. I’m amazed at how slowly I’m adding watts to my FTP.

Brian Kearns: Slowly.

Peter Attia: Cycling is kind of the only thing you are really metric … it’s your metric and I’m blown away. I mean, I think from the spring until now, I mean maybe I’m 10 watts higher, that’s pathetic. Like, I should be like 30 watts higher given how far I am below. Because remember, it’s easy to gain fitness you once had versus building off being at your best, which I’m nowhere near.

I mean I have some strength goals. There are certain lifts I want to be able to hit on my dead lift. And I think there are certain silly things that I want to be able to do again that I’ve done historically, but through injuries, I’ve had a hard time. I can’t tear phone books anymore.

Brad Kearns: You could at one point, when they had phone books. Now they don’t have any, so it’s okay.

Peter Attia: Yeah, I wish that was the only reason I couldn’t. No, my grip strength has declined after an elbow injury. And so, the last time I tried to tear a phonebook, I couldn’t do it and I was … I mean, since college, I’ve been tearing phone books. So, that really bums me out. Not because I care about tearing phone books, but because it makes me realize, wow, I’ve lost that much grip strength.

Then my goals in a race car. I have goals in archery and while those are probably less physically demanding than kind of the cycling, swimming type of goals I had, they’re still very technical, and equally enjoyable for me as far as pursuing.

Brad Kearns: So, what’s the race car all about?

Peter Attia: Meaning, like what are the goals or why do I care?

Brad Kearns: Yeah, kind of what kind of racing do you do?

Peter Attia: I mean, most of the work that we do is actually on a simulator just based on cost and time. So, the simulator’s in the next room. And then when it comes to cars, I like all cars. I like anything that’s built for a purpose race car. Those are the most fun cars. So, streetcars are not that much fun to drive on race tracks because they’re not really built for purpose. But even like a little tiny Miata that’s all specked out for racing, even though it’s a very low powered car, I mean, they’re still incredibly fun to drive on race tracks. The spec class of BMWs, the E30s, the E46s. I love the formula cars, because just the performance is outstanding. You now generate this downforce through the aerodynamics of the car and you can go through corners at speeds you’ve never imagined possible. So, yeah, that’s what that’s all about.

Brad Kearns: Well man, you’re living a fast life. You always got something going on. I appreciate that about you. I think it kind of blends together like these hobbies and passions. They say that you need to nurture those to maximize your ability and your career and to have those outlets. You feel like that’s a good blend for you, that you’re always finding something, archery or what have you?

Peter Attia: I think so. I mean, I think people have different needs, right? There’s like a hierarchy of needs, but I think that for many people, and certainly for me, mastery is a need. The journey, the journey of getting better at something is very important. And that’s probably why when I stopped competitively doing anything athletically; swimming or cycling or even boxing, it was very hard to find pleasure out of those activities recreationally. Because there’s nothing … I’m so far below where I was.

So, when I was time trialing or swimming and doing so as competitively, every month you’re trying to get a little bit better. Each season you’re trying to get a little bit better. You’ve got goals and you’re working towards them. But now, for me to get on my bike, it’s a joke, right? I’m so bad. It’s hard for me to find the mastery in it. There’s still joy in it at some level, but there’s no mastery.

So, that’s why turning to other things like driving a race car or archery where you’re starting at ground zero, there’s incredible pleasure in getting better at something and learning a skill that you don’t monotonically improve in, but you’ll take some steps forward, you’ll take some steps backwards. You know what good looks like because you can see it modeled in others. And you look back over the course of a year and you realize, “Wow, I’ve made progress.” And I don’t know, for some reason, I just think that’s important.

Brad Kearns: Yeah, I feel the same. And keeping it fresh, it might be a personality attribute because I know buddies of mine that I raised with on the pro circuit starting 30 years ago and they’re still going into the amateur ranks. And now, they’re winning the 50 plus division and people ask me all the time, it’s like the first question I get, “Oh, you raced pro for nine years, that’s great. Do you do still do the races for fun?” And I go, “No.” That’s it. I can’t even imagine wanting to, after going all out on something. Do you want to go back to medical school just for fun?

Peter Attia: But your guys who are still racing the over 50, I think in many ways that’s still another form of mastery. In an absolute sense, they’re not getting better. But on an age adjusted basis, potentially they’re still seeing those gains and maybe for them, that’s scratching the same itch.

Brad Kearns: Yeah, the podium’s there for everybody, right? There’s age divisions for a reason. And keep up the good work with your career, man. We appreciate you so much. I know Mark Sisson and I drove down here, what was it now? A year and a half ago, because we had this assignment to write The Keto Reset Diet, and we knew a little bit about keto. And we said, “What should we do now? We have to turn this book in.” And we had a great time with you there at the whiteboard and you explained everything to us. It was a huge part of the operation.

So, that was good to meet you there. And now catch up and find out that you’re in the podcast game. So, how do we subscribe? What the show’s going to be about? What’s your tone and so forth?

Peter Attia: So, the name of the podcast is called The Drive. So, you can find it-

Brad Kearns: Do you have like background show tunes where you have the motor revving up?

Peter Attia: We don’t have driving music (which maybe we should). And you can find it in all the usual spots on iTunes and such. But, the thing that we’re doing as an experiment is putting a stupid amount of work into the show notes. Now again, that may turn out to be not a good use of resources.

Brad Kearns: Rhonda Patrick style, where she does those occasional screens.

Peter Attia: Well, Rhonda does it on the podcast. Rhonda’s are amazing because she’s doing this killer job of the video. We’re not even going down that path yet. But, if you look at the website, if you look at peterattiamd.com/podcast, you’ll see all the podcasts. And you’ll see 10 pages worth of like every detail on everything that we talk about with a hyperlink to this and a description of this and all those things.

So, the feedback so far has been that people have never seen show notes like them and they really love them. And again, if it makes sense, we’ll continue to do that because I think it allows people to get more out of it.

I’m hoping to probably just put one up every single Monday. And we’ve got enough in the pipeline that we have are six months basically worth. So, we’ll get to the end of the year and then decide if we’re going to continue it. And the format seems to be kind of long-form podcast. It’s sort of like … I like what Tim does. I like what Joe Rogan does. I like when people just say, “We’re going to go where we go and it’s going to be …”

Brad Kearns: Get the fuck off the asshole or I’ll kill you next time. Oh sorry, yeah.

Peter Attia: Yeah, I like saying that too.

Brad Kearns: We’re going to do extensive show notes then to honor you. I mean I have that same vision of really providing helpful written content because I’m a writer, and you should see the descriptions of my shows go on and on. I’m like, “Well, I got to stop, I got to go do my other … I’m finishing a book.” But we’ll do kickass show notes and I’m going to find the driver, that pickup truck that was going down that hill and call him out. We’ll find him.

Peter Attia: I wish I could remember the color of his truck and his license plate.

Brad Kearns: You talked about the desire to have a rifle strapped to your bike as one … did we talk about it on the air or off the air? I can’t remember. I mean you could get a body cam, right? Like what do you call the thing on top of your head? The GoPro?

Peter Attia: The GoPro.

Brad Kearns: Any car cuts you off, you get their license plate and we go to town and go straight to the police station.

Peter Attia: Olivia, what are you doing here? I love it. We’re on the air here.

Brad Kearns: If you listened to the first show, the first show on The Drive Podcast, this young lady who just walked in, would you say hello to our fans out there?

Olivia: Hi guys.

Brad Kearns: And can you tell them the name of this podcast?

Olivia: Get Over Yourself.

Brad Kearns: Thank you for listening to the Get Over Yourself Podcast. For Olivia and Peter Attia, this is Brad Kearns, have a nice day.

Hey, do you want to hear an advertisement? If I sing it, would that be a little more palatable? I know that we sometimes get annoyed listening to ads on podcasts. Go ahead and hit the plus 15 or the plus 32nd button if you don’t want to hear this. But I’ve also been exposed to some cool products and services when I listen to ads on certain podcasts. So, once in a while or more than that, I’m going to talk about stuff that I really use and enjoy and completely support. No BS, I absolutely promise that to you.

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And because you’re listening to this ad, I’m going to give you a super-duper top secret 20% off discount off of your enrolment on any of those courses. And that is the code Brad20. Tell your friends. Go for it. Make some changes in life. Do it the right way with complete guidance from me. If you’re sick of my voice from the podcast, maybe it’s time to switch over to a video.

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Thank you for listening to this lengthy ad, and I appreciate you listening the show, also.

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Podcast Episodes

Welcome To The Get Over Yourself Podcast

I clear my throat and set the tone for what to expect on the wild ride that is the Get ...

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I head to San Diego, via Mexico (relevant shortly) to catch up with one of the great health leaders of ...

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