Dr. Peter Attia Zero Q+A | Part I

hey is your community this is Mike Mazur CEO of zero super excited today to answer all of your questions about everything fasting and I'm here today with dr. Peter attea dr. Tiye is a physician focused on helping people live longer and healthier lives and he is also the host of an amazing podcast called the drive you can check out the drive if you haven't already I highly recommend it at Peter attea MD com that's PE ter atti a MD com so download that today and also a little bit of business Peter before we jump into the 1700 plus questions you got asked by the Xero community in the last week you of course can download 0 if you don't already have it on iOS just go to the app store and search for Xero fasting you can check us out on our website at zero fasting comm and I'm very excited to let you guys know that we are finally after a long hiatus on Android so go to the Google Play Store search for Xero fasting look out for imposters there are a couple copycats out there so make sure you go to zero fasting look for the orange Sun with the clouds and get it on your Android now it looks great with that we will dive into the questions Peter if you're ready yeah you guys know how this works if you saw my last one with dr. Rhonda Patrick we obviously can't get through all 1,700 questions but the good news is there were some very thematic questions that came up and we sort of parse through them and picked out the representative questions that we thought would hopefully answer many of those seventeen hundred's for you guys so we'll head right into it now and so the first question is from Sierra and this is actually we talked a lot about coffee with Rhonda but people keep wanting to ask about curvy and so Sierra asks does black coffee or herbal tea break a fast I've heard conflicting ideas I agreed this is a question I probably get asked more than anything certainly on social media I get asked constantly and so the first thing I want to say is one I don't think anybody knows the answer to any question we're about to answer today we have to you know if there's anything where I'm gonna answer a question and I can tell you I know that that's guaranteed to be correct I'll stay so but my default is everything we're saying we're somewhat speculating on the second point I'd make here especially with respect to this question but it's true for many questions about timer circuit feeding and fasting is it depends on your objective so let's use sort of two or three examples of why people would use time restricted feeding now one approach might be for weight loss that might be you know kind of a thin end of the wedge that gets people interested in doing this sort of thing another reason someone might do it is they're having lots of GI issues either upper GI issues they have a lot of reflux or they just have quote/unquote gut issues IBS yeah exactly yeah and yet another issue that someone might think about doing this for is you know they've they've read enough or they listen to podcast and they've kind of got a sense that there's this thing called the tofu G or mite otha G you know ways that you can reduce inflammation and sort of you know stuff bad cells and they're kind of wondering like if fasting is a tool for that does this coffee break it so this certainly falls in the category of something I don't know the answer to and it comes down to thank you wait we don't have really good clinical trials that give us largely definitive answers and to some of these things are very difficult to measure the top of G which I'm sure we're going to talk about I think I even saw a question about this specifically we we certainly know what a coffee is and I'll explain it when we get to it but we don't have a tool to measure it it's not like saying having a fever where I could put a thermometer in your mouth or your ear and look at the number and define a fever according to that we don't have type of a metric for a tofu G so directionally here's what I sort of explain to patients if the purpose of your fast or if your main objective around the time restriction and/or the fasting is this is to deprive yourself of calories for the purpose of losing weight I don't really think black coffee is impairing that particularly now that's not to say that black coffee or any form of caffeine is inert and it certainly does things as far as probably change the way you metabolize fat but it's not a source of calorie and any one of those alterations that it has probably isn't playing a significant role in you achieving that goal and we do hear from a lot of folks that they find that the black coffee and the caffeine actually really helps curb hunger so if they're if they're having trouble sticking to the tariff or the fasting it's it's a huge benefit for them that's right and even when we have patients in our practice doing longer fasts if they are very significant caffeine consumers we basically say you have sort of two choices you either have to wean yourself off coffee in the week or so you handing up to the fast or I would recommend you stay with it because to go cold turkey into a fast without coffee will produce a whole bunch of other problems as well now let's say for example the person says no I want to do this fast because I'm interested in really giving my gut rest I mean you know complete and total rest such that I can heal from sort of whatever element I have well in that situation I think coffee would be breaking the fast because it's basically introducing something that's going to alter the gastric pH and alter basically everything that flows beneath it into the gut so those two examples I think how people think about this so if you're if you're asking the question does coffee break a fast I would ask the second-order question which is why am i doing this fast right now the second thing I think in this question is herbal tea and I think there my view has been herbal tea does not really break a fast and even when I do my very long water-only fast I'm basically consuming flat water bottled water herbal tea and bullion which is just you know basically sodium in water right and so I've never viewed that as breaking a fast and the last point I'd make on this so this is a great expression my brother always reiterates in life which is major the major minor in the modern it's like you don't want to get too hung up in the most little tiny piece of minutiae around well what about this type of herbal tea or that type of herbal tea you know that's like probably a tenth order term and we should probably just focus on a really big picture I know a lot of people in our audience may not know the distinction that you want to draw between time restricted feeding and fasting you want to quickly for a definitional purpose kind of distinguish those two yeah sure I think it's there's there's kind of like the black white and the gray I think most people would get that if we're talking about going three four or five seven days without eating anything you know only consuming water I think that's pretty clearly fasting by most people's standards conversely if we were talking about say twelve hours of not eating twelve hours of eating which like it's almost natural to most people probably wouldn't call that fasting that would be clearly time restriction and it's a continuum right so if you go from say twelve hours of eating in twelve hours of not eating to sixteen hours of not eating in eight hours of eating you know where is that on the continuum you know in my in my book that is still part of what I call time restricted feeding where I think it gets grey is once you exceed about a day you know if someone said well I'm gonna eat every other day for example which by the way is kind of an awkward protocol that would really be on the verge of time restricted feeding versus faster so I think for the purpose of probably the most questions that I just saw in a few minutes we glanced through them my intuition was most of these people were asking through the lens of time restricted feeding is that kind of how you yeah you saw more of them I think yeah exactly it's useful to have that definition and we I guess we use fasting as shorthand yeah yeah but but I know that you like to be more precise and that's useful so I think yeah most people using zero or practicing consistent daily or nearly daily timers - feeding with us the circadian rhythm fast we offer or the or the one meal a day but there are there's a there's a significant amount of users that do that what you're calling true fasting which is longer than 24 hours they might not do that you know every week or every day but they're doing it sort of episodically yeah so it's good to know the distinction but yes most of these are around time restricted feeding so Michelle is asking what is the best type of food to break it fast with and I want to add onto this question because we get a lot of questions how should I break a fast and that's obvious I've actually found that has an important question I want to sort of good you know co-op some of Michelle's question is how to enter a fast because I find that entering a fast after you know maybe having a pizza night we're having a few beers makes my fast really difficult whereas if I enter from a state of eating well and and even the best case in the state of ketosis everything just gets way easier yeah so I think for this question I'll answer it through the lens of not just a sort of sixteen eight time restricted feeding but say someone who's doing their first three day fast or so everything like that so you kind of already I think hit the nail on the head which is I've tried this both myself and with my patients I think the easiest way to enter a fast is actually through a state of nutritional ketosis which is obviously not the same as starvation ketosis which is what happens when you fast you instead of dying which you normally would if you couldn't enter ketosis your body figures out a way to use fat to break that fat down which allows you to spare your muscle so you won't have to break down muscle to make glucose and it makes a basically a glucose substitute for the brain called ketones and if you can already have that system primed going in you do tend to suffer a little bit less on the on the way in there's no two ways about it I mean you know your first time fasting it's it's definitely a shock to your system I've never met anybody who you know did a three-day water-only fast out of the gate and said oh I didn't even notice that right it's definitely a change but it if you do it correctly and one of the ways to do it in fact the way that I think is probably most important is to enter through a state of nutritional ketosis even if you're only there for three or four days it really doesn't feel all that different from just being a little hungry now to the tip is Michelle's question yeah Michelle so it's Michelle's question on the exit you know this is one of those things I've learned the hard way myself which is if you if you eat too much on the exit especially for somewhat longer fasts you're gonna pay the fiddler you know your stomach really shrinks down during these fasts and so to put a lot of volume in there or will create gastric distension the other thing that may be not to get too nerdy on this but when you're fasting your body goes into a physiologic state of insulin resistance so let's say you're five days into a fast you're at that point your muscles are doing a very good job to make sure all of the glucose that's circulating is preserved for the brain and at that point your muscles have really switched over to rely on fatty acids and ketones so again your glucose is still gonna supply at least half the energy of your brain even under the longest fast imaginable ketones providing the rest but the muscles are gonna rely less and less on glucose now if you let's just say you break a fast with a pizza well there's a ton of glucose in there and your glucose is going to skyrocket when you need that more than you would expect given how glycogen depleted you are because of this short-term transient insulin resistance and as that spikes your body's gonna do everything in its power to try to normalize glucose levels and it will invariably rebound and overshoot and you'll go from having you know a glucose here when you finish the fast to here when you finish the pizza to here later in the day won't crash and yeah so what you want to do is kind of avoid that cycle so I like to having tried a number of different protocols I like to break the fast with a meal that is also restricted in carbohydrates and not too big you know sounds like the big key is just limit the portion small volume for what it's worth like I why but I like to break a fast with kind of a small salad and the longer fast that is and for reasons I don't know like a small bowl of chili or scrambled eggs or something like that but not too much okay and for a time restricted fast which you know like breaking a 16-8 or a 20 for less concern about I think so I think for most people once they kind of get into that groove there they they can eat anything which doesn't mean they should eat anything right but they can they tend to be able to eat with it less sensitive and the stomach shrinking yeah in my experience that sort of shrinking transient transient insulin resistance muscles seems to happen around the third or fifth day okay let's go back up to Laura's question and this is a multi-part er but I think it covers some really important topics so Laura asks I would like to know if medication vitamins and supplements I guess and or supplements break your fast and the second part is if it doesn't or if it doesn't does it affect etapa G so does it break it fast as it affected top of G and those are sort of combined ideas it's a great question again same caveat don't really know the answer because we don't have you know meaningful human clinical trials that can answer the question definitively as a general rule one I'm fasting and when we have our patients fast we generally pare back on many of their medications one of the simple ones that we can easily forget - if patients are taking them are fish oils and things like that vitamin D so all of the fat soluble things they probably don't move the needle much if they stay on board but they are technically nutrients so I do generally pair those things back and that includes things like branch chain amino acids if you're exercising which I think we're going to talk about exercise I saw a question about it even though the total number of calories and these things is pretty low I think for the sake of completeness you probably just want to go and restrict those things as well now if you're going to restrict actual medications you really have to do this through the lens of working with your physician and this is where it gets a little more complicated for example if patients take medications for diabetes or take medications for blood pressure or anything like that those at those should not be stopped with that your doctor explicitly saying yes no taper off you know something like that right yeah actually interject that everything we talked about say in the podcast is not should not be construed as medical advice and will have all the caveats but it's really just directional information and always check with your doctor before thinking about embarking on a fast yep in terms of the toffee gp's well this gets to kind of one of the three or four biggest you know things that sort of chaps my hide which is we certainly know a lot about apology from the standpoint of studying it in in animals but we really don't have a great sense of how to measure this in friends and so so you think we'll get there do you think well yeah yeah we absolutely will we absolutely will because you know the funny thing is this is a great example of the difference between basic science and translational medicine when you when I speak with the world's experts from a basic science perspective on a topic GM talk about their work it's the most incredible you know fun time ever and then when I pass it to them hey do you know if you do a blood test on somebody who's been fasting for seven days what signature you would see that could tell us how much or to what extent the top vidyou is happening don't often say things like oh would that be interesting to know which I say yes hell yes that was very nice I take a muscle biopsy yeah that's right muscle biopsies or do things that we're just simply not gonna be able to do so yeah I think this is just an example of taking something that's so interesting at the basic science level it's worth pointing out the Nobel Prize in 2017 was actually awarded for the genetic elucidation or the elucidation of the genetic regulation of the top of G so this is a type of mind in the tsiyon top top of mine super important problem in science and but look the fact that people are responding with questions about a topic with fasting app says we have to just bridge that gap and so yeah I'm totally confident that you know within a few years we're going to have the tools to answer these questions correctly and not have to speculate as much cool let's move on to more about food Chris asks what what types of food in terms of macro micro nutrition are best to eat after fasting I have issues with lethargy from blood sugar spikes after eating so you've already covered yeah I think what Chris is experiencing is very likely the response of the sort of glycemic rollercoaster one of the things that I think you've heard a lot because you and I've talked about it and you you you've experienced it personally but also you just tell you that you know users tell you this and my patients tell me this all the time it's counterintuitive at first but once you free yourself from the what I call the drip of constant food you just sort of realized that mental clarity that comes from this the ability to have regulated energy levels is remarkable and and so what what I think Chris's question is speaking to is the opposite of that and that's a little bit of the you know any you know anytime you can transition from fasting to feeding with the least disruption of glucose levels which basically means eating far more complex carbohydrates lots of both soluble and insoluble fiber together people tend to batch those one or the other more fat more protein you're probably going to experience less of that rollercoaster yeah I mean I know for for me time restricted feeding is absolutely a lifestyle now in large part just because my energy balance is so much more reliable well you know not having the the sandwich at lunch which you know so many people just do without even thinking and then wondering why you're falling asleep at your desk or in a meeting at 1:30 in the afternoon it's just taking taking away all of the digestion and all the meta like factors that go into like that that spike in crash make me more productive through the day and I think a lot of our users see that as well yeah I mean 12 13 14 years ago I remember and I was working at a company in San Francisco that it was my first time after I left medicine going into the real world and I'm at this company that has like the best food I've ever seen it's just a constant buffet all around you right everywhere and I just couldn't get enough of the fact that I could have M&Ms anytime I wanted like if you wanted to go and get a coffee or get tea or get a soda or whatever they also had like 20 jars of crap and it's not like I didn't know that it was bad to eat these M&Ms but I just couldn't help it it was like you had to have a handful every time you'd go or bring a little cup back to your desk whatever knows and I think back on those days and not only was I you know obviously much less healthy but how how much I had to fight to stay awake we talked about this earlier you know before the show your food and environment yeah unform so many of your choices and also the fact that I think why people have such success with fasting is that it's binary you it's not like it can I have 10 M&Ms that's right will that be okay or can I have half a muffin it's just I am blocking out this time for my digestion to rest and then I will eat the right stuff when I can I completely agree certainly for me that's that's the case I function much better in a digital than an analog right right so another question on top of G and I think the same cabinets will apply that it's really hard to measure but it comes up so often we want to just address it again Marcia asks how long does it take for your body to enter a Tov G after fasting I assume she means after being in a fast or feeding how many hours of do you need a fasting to get the benefits of esophageal and brain health thank you well again excellent question there need like general guidelines or thesis on how long the take I mean I would say the following four otology to probably reach the level that it's going to have a clinical impact you have to be far enough away from nutrients that you would probably start to see measurable changes mm-hmm so what would those be well I suspect if we had the ability to measure easily we can do this in a lab but if we could clinically measure levels of amino acids I suspect that we'd get some insight from that but maybe not much I'll use one example I'll use two leucine and methionine which I'm sure most people have heard of our amino acids and they're both very important amino acids leucine is probably one of the most important amino acids for building muscle so if you want to build muscle you generally need additional leucine but the body will preserve leucine levels in a fast almost indefinitely so we're really good at keeping a normal level we just can't have a super normal level so that would suggest to me that leucine levels probably wouldn't offer much of an insight but methionine levels do tend to drop now it might be that they drop too fast and that is also not sensitive enough because even a day of not eating should drop methionine levels one of the things that I have relied on as a proxy is glucose levels because glucose levels are impacted by certainly what you eat that's the most obvious thing but there are in fact in a lot by stress cortisol levels exercise will drive glucose up if it's intense enough but by wearing a continuous glucose monitor which you know I do and we've got one on you yet have we I'm gonna get some six all right yeah there we go on point so so what you'll realize when you put one of these things on is you you really start to get a sense of a change at about three days into a fast okay and I I mean I know the first day and a half and even two days of fasting if you look at my glucose levels they don't look that different and just what I needed Wow and I think a lot of that's just driven by cortisol I think you do have a sort of short term burst in cortisol the body is probably scrambling a little bit to break down fatty acid so you're seeing adrenaline or adrenaline go up and a lot of that can have an impact on breaking down glucose as well as breaking down fat I know I feel that we'll get to that when we talk about sleep because I have you know I think that cortisol spike is yep sure asleep but I'll tell you this by day three yeah all of that fluctuation glucose gone so you're thinking there's some proxy for glucose levels and potentially otology happening well the we can measure the glucose levels directly I'm wondering if that complete flattening of glucose and it tends to for me flatten down to around 60 milligrams per deciliter which is a little over three millimolar and it's about three and a half zero it's pretty low but once I hit that and I get to the point where there's really no changing it the only thing that's gonna really make it burst is if I do something really stressful and I'm a sort of transient cortisol spike or if I do a hard workout which I will do at least once a day it might rise up to 80 or 90 but then it pretty quickly comes back in a 60 I feel like when I'm in that spot that's probably if I could measure it when etapa G is in full force yeah because I don't think a kapha G's really gonna take place when nutrients are that viable and I Coast is at least as easy a nutrient to measure as others for what it's worth if we wanted to get in more detail I've also looked at free fatty acid levels as that changes over the fast insulin levels also tend to really plummet and so certainly that that's that's sort of my impression but again until we have the tools to measure it it's not clear and in fact we don't even really know how binary the tofu G is like we talk about it as though it's one thing but it's probably also on somewhat of a spectrum hmm cool well it sounds like for anyone in the autopsy science field out there let's accelerate the ability to be able to measure it easily yeah I'm convinced that if that there is a signature and would involve sort of small molecules proteomics metabolomics probably something in the gut I'm sure there's a gut signature as well and that that if you've put all together would be a really valuable clinical assay to help people figure out what for example the minimum effective dose is for a fast and you know all I can where where do you pass the point of diminishing returns in that source it sounds like it would be a very popular item for clinicians and patients let's move on to exercise that we get tons of questions about you know ty prescriptive feeding fasting and exercise this is from Martin fasting and muscle building is it wise to train fasted when you want to build muscle well yeah this definitely depends on what you mean by fasted I know first of all I should caveat this by saying I don't know much about building muscle that's just not an area I've spent much time concentrating on and I don't it's never really been a priority for me or my patients outside of physiologically what's normal that said intermittent fasting meaning you know three day five day seven day fasts every you know cycle several times throughout the year does not appear to impair muscle building and we'll talk a little bit about some strategies around that and certainly time restricted feeding if done correctly and supplemented with the right nutrition in the feeding window does not appear does not appear to impair muscle building at all a couple things to keep in mind if your and I do this with certain patients if your priority is putting on muscle but you also want to do time restricted feeding you have to be thoughtful about when you're going to exercise so obviously the most important thing you're going to do to build muscle is you have to do resistance training right and let's say you're doing kind of the socially acceptable time restricted feeding window which is you're eating at the end of the day and at the beginning of the day well if your schedule permits it you are far better off exercising at the end of your fasted window so that you can feed immediately post so just just an example you're you're a religious sixteen eight person you know everyday you know let's say you you have your you the fast at 6:00 p.m. you eat at 6:00 p.m. or actually no sorry you either so you either ate and you started new yeah then you want to be working out by at 10:00 yeah exactly yeah you wouldn't want to do the you know 6:00 a.m. workout right because if you're really adhering the time restricted feeding you should not even be consuming a branched chain amino acid or anything like that during that workout and so you know you'll be a little bit catabolic post-workout without any of the nutrients now again this is not necessarily to say that you can't do that thing and and I don't think you're losing muscle by doing that but if you're really optimizing around putting on as much muscle as possible I think you'd be better off throwing that the the strength frame either in the feeding window or just before this before it I hear a lot of people do it just before then they kind of get their work in out-of-the-way fasted and then can consume calories yeah and if you if there's like say a 30-minute gap between when you finish exercising and when you start eating you you actually will experience some of the insulin sensitivity benefits of the exercise as well so yeah that's kind of another benefit to disposing of glucose cool let's talk about some challenges people have while they're fasting this is from Kapila and the question is dr. Peter huh I started having headaches every time I fast longer than 10 to 12 hours black coffee helps at times but I wonder is it something that requires to be looked into and how can I avoid the headaches thanks and regards I don't know if this is a caffeine mostly but I would say the fact that he mentions that black coffee helps yeah makes me wonder if this is caffeine withdrawal yeah sounds like it could be and again I've seen this with certain patients one should not really experience a headache with 12 hours of 90 that's a pretty strong grade incorrectly window yeah that would be considered I wouldn't even really consider that fasting so I suspect that what he's experiencing is caffeine withdrawal yeah because if you're you know getting enough water it's hard to imagine why you'd experience headaches repeatedly at that agreeing that duration yeah okay let's move on to fasting consistency a question around consistency this is from Joe a huge fan of your work and the message you send when it comes to fasting do you believe it to be more beneficial to be in a routine consistent fasting protocol or fasting whenever you're able to randomly fasting for 16 hours for example I work in professional sports and our schedules are not ideal for meal timing and sticking to a consisting consistent fasting schedule so that's probably common for a lot of people they maybe they have business trips so they have social engagements so they're all over the place is there yeah well again I always take a step back and say what is this relative to right so was it was Joe yeah yeah so it sounds like Joe's busy so if Joe's default is you know eating sort of crap whenever it's available that's suboptimal and if the best thing that Joe can do is use fasting as a tool to save his meals for when he has better control over them then that's a win now what if that's all he can do what if it's like you know I've done this in the past as I'll give you an example where I say look I'm always gonna use my flight day as a fasting day because it's a day when I'm generally less in control of what I can eat you know airports have crappy food my airplanes have crashed that's active you're not yeah yeah so look I'm just gonna use this as a tool to minimize the damage that would otherwise come into my life right as a result of this thing I have to do so what do you do if you have to like travel internationally in business class and all the cheese's and fine wines are flowing by have you really for any much I never make a fasting day exactly but yeah but for the normal coach travel for the for the way I do 90% of my travel which is bad airports bad airplanes bad right that becomes an effective tool in fact for what it's worth you know I do those seven day fasts every quarter I always do it in the same way which is I always start on a Sunday flight to New York interests and part of your protocol or my protocol and it's just like I'm not eating on this plane and I'm gonna land in New York and I'm not eating and I get to my apartment and I only got my topo Chico and away I tell my Chico break it fast no no okay I make a very hard case to say that when she can make the fast so so now that said yeah the next layer here for Joe is okay yeah I'm gonna I'm gonna do fasting as both a tool to cope with you know the curveball and getting thrown mm-hmm but I'm also going to find a way to regularly do something superimposed on top of that right so it sound if I'm if I'm summarizing it sounds like even if the schedules doesn't allow them to do at the same time the consistency of the practice is sort of carrying the day yeah and truthfully we don't know the answer about whether or not the body you know people use this term is good to shock your body I mean the reality is I don't think we know the answer to that question we know that the body adapts so whatever you do to the body it will adapt which is why we change our training but there are some things that we don't change right like my body can adapt negatively to something as well so I guess we're unfortunately still in our infancy of understanding this but if I guess if joe keeps his eye on the on the on the on the big picture which is whatever he's doing to minimize eating a standard american diet he's gonna be do better feel better yeah never so we've just gotten through the first batch of questions for the second batch of questions we invite you to come on over to zero download it it's completely free again in the Play Store or in the App Store look for zero fasting and you'll find the second part of this interview the Learn area so just let me write at the top of the learn area bottom right of the tap tap learn and you'll find part 2 of this amazing community with dr. Peter Atia thanks

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Views: 152,460

Rating: 4.8955679 out of 5

Keywords: fasting, time-restricted eating, trf, intermittent fasting, ketosis, autophagy, health

Id: 9KgX8xR5gw0

Length: 34min 45sec (2085 seconds)

Published: Thu Apr 04 2019