← The Peter Attia Drive

#11 - AMA #2: the Nothingburger — results from Peter's week-long fast between two weeks of nutritional ketosis — and answering questions on all things fasting

Aug 23, 2018 1h 50m 28 insights
<p>Consider this episode a cross between an ask me anything (AMA) and a show-and-tell. Peter discusses his fasting experiment in great detail and answers questions from listeners and readers.</p> <p>We discuss:</p> <ul> <li>Why Peter did a one-week fast and the rationale for front- and back-ending it with a week-long ketogenic diet [6:30];</li> <li>What Peter's typical diet, exercise, sleep, stress management, and supplementation looks like [11:00];</li> <li>What labs (e.g., glucose, ketones, lipids, inflammation and oxidation markers, thyroid- and sex hormones) Peter checked for the experiment [22:00];</li> <li>Peter's results after a week on a ketogenic diet [29:30];</li> <li>Peter's results after a week on a water-only fast [48:45];</li> <li>Peter's results after a week on a ketogenic diet following a week of fasting [58:30];</li> <li>Peter's "Top 6" surprises from the fasting experiment [1:08:30];</li> <li>Different fasting-mimicking diet (FMD) protocols [1:29:20];</li> <li>What is the optimal protocol, frequency, and duration for fasting? [1:33:00];</li> <li>How to break a fast without GI distress? [1:38:00];</li> <li>"Am I breaking the fast if…?" [1:41:30]; and</li> <li>More.</li> </ul> <p> <span> Learn more at <a href="http://www.peterattiamd.com/"><span><u>www.PeterAttiaMD.com</u></span></a></span></p> <p> <span>Connect with Peter on <a href=""> <span> <u>Facebook</u></span></a> | <a href=""> <span> <u>Twitter</u></span></a> | <a href=""> <span> <u>Instagram</u></span></a>.</span></p>
Actionable Insights

1. Implement Nutrient Cycling for Longevity

Incorporate regular periods of fasting and feeding into your lifestyle to promote longevity by cycling autophagy, anabolism, and catabolism, as well as mTOR activity.

2. Maintain Exercise During Fasting

Continue your regular exercise routine, especially weight training, during fasting periods to help preserve muscle mass and send a signal to the muscle to prevent shrinking. While strength may be preserved, high-cadence cardio might be more difficult.

3. Prepare for Fasting with Ketosis

Enter a fasting period from a state of nutritional ketosis to ease the transition and reduce discomfort, as the body will have already ramped up ketone production.

4. Refeed with Ketosis to Prevent Overeating

Exit a prolonged fast by re-entering a ketogenic diet to guard against overeating junk food and maintain reasonable eating habits during the refeeding period.

5. Reintroduce Food Gradually After Fast

Be cautious with the volume of food consumed immediately after a fast to avoid gastrointestinal discomfort, such as hiccups, due to the stomach being decompressed. Start with small, light meals.

6. Adopt Time-Restricted Feeding

Consistently practice time-restricted feeding, aiming for a daily eating window of 2-10 hours (14-22 hours of restriction), most days of the week.

7. Avoid Junk Food and Processed Carbs

Limit or avoid abject junk food, sucrose, high fructose corn syrup, and processed carbohydrates like potato chips to maintain a healthier diet.

8. Individualize Supplement Regimen

Recognize that supplement needs are highly individual; consult with a professional to determine a personalized regimen rather than blindly following what others take.

9. Increase Fasting Frequency if Metabolically Unhealthy

If in a metabolically poor state (e.g., diabetic, hyperinsulinemic, metabolic syndrome), consider increasing the frequency of fasting periods like Fasting Mimicking Diets (FMDs), and potentially reduce frequency as metabolic health improves.

10. Adjust Fasting Frequency Based on Diet Quality

Tailor your fasting frequency to your regular dietary habits; if you tend to eat less healthily, more frequent fasting may be necessary to mitigate damage, whereas a consistently clean diet might require less frequent fasting.

11. Practice Consistent Mindfulness Meditation

Maintain a regular routine of mindfulness meditation, as it can foster a unique sense of calmness and presence, especially during periods like fasting.

12. Track Sleep Consistently

Use a wearable device like an Oura ring to consistently track sleep duration, efficiency, and sleep stages (light, deep, REM) to gain insights into sleep quality.

13. Increase Electrolytes During Ketosis/Fasting

Supplement with increased magnesium and sodium (e.g., via bouillon) during ketosis and fasting periods to counteract electrolyte wasting by the kidneys, which can prevent lightheadedness and cramping.

14. Define Fasting Goals

Clearly understand your specific reasons for fasting (e.g., weight loss, autophagy, metabolic health) to guide decisions about what, if anything, you consume during the fast.

15. Avoid Artificial Sweeteners During Fast

Refrain from consuming artificial sweeteners or chewing gum during a fast, as they can potentially stimulate appetite and disrupt the benefits of the fasted state.

16. Consider Morning Main Meal for Circadian Rhythm

Experiment with shifting your largest meal to the morning and tapering food intake throughout the day to align with circadian rhythm and potentially optimize glucose disposal and insulin sensitivity.

17. Use DEXA Scans for Body Composition

Utilize DEXA scans to track body composition changes, ideally using the same machine and operator for consistent and accurate results over time.

18. Consume FMD Calories in One Meal

When following a Fasting Mimicking Diet (FMD), consume all allowed calories in a single meal, preferably dinner, to satisfy social needs and potentially enhance the feeling of satiety.

19. Prefer High-Carb FMD for Volume

For Fasting Mimicking Diets, a high-carb, low-protein, low-fat approach (e.g., salad and rice) can offer greater volumetric satisfaction compared to a low-carb, high-fat FMD.

20. Track Blood Glucose with CGM

Use a Continuous Glucose Monitor (CGM) like the Dexcom G6 for highly accurate and continuous tracking of blood glucose levels, which is more insightful than finger sticks and doesn’t require calibration.

21. Aim for Optimal Blood Glucose

Strive for an average blood glucose level between 85-90 mg/dL for optimal metabolic health.

22. Aim for Optimal Lipid Markers

Target specific lipid markers for cardiovascular health: LDL-P below 800 nanomole/liter, C-reactive protein below 1 mg/L (ideally below 0.5 mg/L), oxidized LDL below 40 U/L, uric acid below 5 mg/dL, and homocysteine below 9 µmol/L.

23. Aim for Optimal Thyroid Markers

Monitor thyroid function by aiming for TSH below 2 µIU/mL and a free T3 to reverse T3 ratio above 0.2, as these indicate healthy thyroid activity.

24. Consider Dutch Test for Adrenal Health

Use a Dutch test (dried urine test) to measure cortisol and cortisol metabolites, providing a comprehensive assessment of total adrenal output and free cortisol levels, which are more indicative than plasma cortisol.

25. Use Photos for Muscle Mass Assessment

Take sequential photos (e.g., seven days apart) as a simple, zeroth-order method to visually assess changes in muscle mass during dietary experiments.

26. Increase Dental Hygiene During Fasting

During prolonged fasting, increase dental hygiene (e.g., brushing teeth multiple times a day and savoring the toothpaste) to combat taste monotony and enjoy the sensation.

27. Review Podcast Show Notes

Always review the show notes for podcasts, especially those discussing experiments or data, as they often contain detailed information and metrics not fully covered in the audio.

28. Use AMA Page for Questions

Utilize the upcoming AMA page on the website to submit questions, allowing for more efficient aggregation and tabulation of popular topics.