The Peter Attia Drive - #45 - AMA #4: sleep, jet lag protocol, autophagy, metformin, and more

Episode Date: March 18, 2019

In this “Ask Me Anything” (AMA) episode, the first subscriber-only edition, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter’s head of research, asks the questions. As a reminder, AMAs are for subscribers only. If you want to subscribe, you can learn more about the benefits at https://peterattiamd.com/subscribe. If you are a subscriber, you can watch or listen to this in full on the show notes portion of our website. If you are listening to this on a podcast player, you will hear a sneak peek of this AMA and then will have to finish listening or watching on the website. All questions are pulled from the AMA section on the website (https://peterattiamd.com/ask-me-anything/). Any subscriber is welcome to submit questions.   We discuss: Blue light blockers and how they improve sleep [1:30]; How to minimize jet lag and sleep disruption while traveling [6:45]; How to treat symptoms of PMS, the female hormone cycle, testosterone in women, and estrogen in men [15:45]; Autophagy: what it is, why it matters, and how can we enhance it [26:15]; The two-minute drill (and a bonus Patriots and Tom Brady tangent) [41:15]; Has Peter thought about having CME accredited content for people in the medical field? [44:15]; How does one find good doctors that are somewhat up to date on the latest research, primary care, etc.? [45:45]; What values would Peter be interested in monitoring continuously if the tech existed? [47:15]; How to annoy Peter [49:15]; If I'm interested in longevity, should I do a Ph.D. or M.D.? [50:00]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

Hey everyone, welcome to the Peter Atia Drive. I'm your host, Peter Atia. The drive is a result of my hunger for optimizing performance, health, longevity, critical thinking, along with a few other obsessions along the way. I've spent the last several years working with some of the most successful top performing individuals in the world, and this podcast is my attempt to synthesize what I've learned along the way to help you live a higher quality, more fulfilling life. If you enjoy this podcast, you can find more information on today's episode and other topics at peteratia-md.com.

Hey everybody, welcome to this week's episode of The Drive. I'd like to take a couple of minutes to talk about why we don't run ads on this podcast and why instead we've chosen to rely entirely on listener support. If you're listening to this, you probably already know, but the two things I care most about, professionally, are how to live longer and how to live better. I have a complete fascination and obsession with this topic. I practice it professionally, and I've seen firsthand how access to information is basically all people

need to make better decisions and improve the quality of their lives. Curating and sharing this knowledge is not easy, and even before starting the podcast, that became clear to me. The sheer volume of material published in this space is overwhelming. I'm fortunate to have a great team that helps me continue learning and sharing this space is overwhelming. I'm fortunate to have a great team that helps me continue learning and sharing this information with you. To take one example, our show notes are in a league of their own. In fact, we now have a full-time person that is dedicated to producing those, and the feedback has mirrored this. So all of this raises a natural question. How will we continue to fund the work necessary to support this?

As you probably know, the tried and true way to do this is to sell ads, but after a lot of contemplation, that model just doesn't feel right to me for a few reasons. Now the first and most important of these is trust. I'm not sure how you could trust me if I'm telling you about something when you know I'm being paid by the company that makes it to tell you about it. Another reason selling ads doesn't feel right to me is because I just know myself. I have a really hard time advocating for something that I'm not absolutely nuts for. So if I don't feel that way about something, I don't know how I can talk about it enthusiastically.

So instead of selling ads, I've chosen to do what a handful of others have proved can work over time. And that is to create a subscriber support model for my audience. This keeps my relationship with you, both simple and honest. If you value what I'm doing, you can become a member and support us at whatever level works for you. In exchange, you'll get the benefits above and beyond what's available for free. It's that simple.

It's my goal to ensure that no matter what level you choose to support us at, you will get back more than you give. So for example, members will receive full access to the exclusive show notes, including other things that we plan to build upon, such as the downloadable transcripts for each episode. These are useful beyond just the podcast, especially given the technical nature of many of our shows. Members also get exclusive access to listen to and participate in the regular Ask Me Anything episodes.

That means asking questions directly into the AMA portal and also getting to hear these podcasts when they come out. Lastly, and this is something I'm really excited about, I want my supporters to get the best deals possible on the products that I love. And as I said, we're not taking ad dollars from anyone, but instead, what I'd like to do is work with companies who make the products that I already love

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Welcome to AMA number four. I am joined again by Bob Kaplan, my head of research. This will be our first subscriber only AMA. If you're a subscriber, you can watch or listen to this full episode on our website. If you're listening to this on a podcast player, you'll be able to hear a preview on the AMA, and then you'll have to finish listening or watching on the website. As a reminder, we pull these questions from the AMA forum, and any subscriber is welcome to participate. In this episode, we talk about the following.

Blue blocking glasses and lighting, cortisol and sleep, my jet lag protocol, a discussion about PMS and the hormones around it, a discussion around autophagy, and then we close with a rapid fire which gets into some issues like CME for podcasts, how to find a good doctor, interesting biomarkers to monitor if the tech was not an issue, and the idea of a PhD versus an MD if you wanted to study longevity. Welcome to AMA number four. Welcome everyone to ask me anything. Before I guess we're starting, Peter,

what's up with those glasses? Ah, the glasses. These are one of my two favorite sets of glasses that I like to wear when I'm looking at electronics in the evening. This brand, which I am neither sponsored by nor received any compensation from, but I do fancy is called Gunner, GU NNAR. And I went through a bunch of these before deciding on the, that these are the ones I liked

more than the others. I started out with gaming glasses first and I just didn't find that I had enough sort of coverage. So for whatever reason, these optics are the ones I like the most. They have a ton of stuff on there and they're not that expensive and they usually have sales. So when they have a sale, I recommend buying like two or three pair and then figure out which one you're going to like the most. There's another brand that I like whose name I'm blanking on now that's not a gunner, but it's a pretty solid brand. There's another brand that I like whose name I'm blanking on now that's not a gunner, but it's a pretty solid brand. It's about twice as expensive, though, with these guys you're into about 40 bucks. The main issue is if you can remember to do so,

putting these on once the sun goes down as you're looking at electronics, huge difference, especially for computer. So I'm more of a laptop guy than I am a phone guy, and I'm usually working on a computer, I don't know, till at least an hour before bed, unfortunately. And this is key, whereas on the phone, there is a setting that renders the phone completely red or completely gray, which is different from just the usual light setting on the phone.

And that usually is more than adequate than needing these glasses. And on the laptop too, at least for the Mac, they have the F-Lux, which will take the light down. And that's pretty good. I do that as well. I kind of view the glasses as an insurance policy. And I definitely notice a difference in my sleep quality, at least objectively, and sometimes subjectively, based on my remembering to do that. And there are times I just, I don't know, I space, I don't do it, and I'm going to bed

having just been blasted by that light, and it sort of sucks. Do we want to explain what's actually going on when you're wearing blue blockers? It's probably taking us back a little bit with the glasses. But what is it actually doing? It actually seems like it's one of those hacks for lack of a better term that is effective in terms of light and sleep and circadian rhythms.

Yeah, so I mean, I think to understand sleep, you've got to think of three things. So sleep is kind of like a balancing act of forces. Now this is a gross oversimplification and you know in our podcast with Matthew Walker, we're going to go into much more detail on sleep, but I'd like to think of sleep as a balancing act between cortisol, melatonin, and adenosine. So we'll talk about each of those for a second. So adenosine, if that sounds familiar, it's because you remember from high school biology that ATP, which is the currency of energy, is adenosine

triphosphate. So the way to think about adenosine is it's something that gets built up the more energy you've expended. So if you were to measure adenosine levels in the morning and then adenosine levels in the evening, they should be higher if you've been doing something. And so that's the first thing you want happening when you sleep is you want adenosine levels to be high. And in fact, that's actually how caffeine works. Caffeine keeps you awake by lowering adenosine levels. Second thing you want is cortisol. Cortisol has to go down and I've spoken about this a little bit before, but basically you

have a cycle to cortisol. So if the x-axis is time and that's the moment you wake up and that's the moment you go to bed and that's your cortisol level, you want to wake up at a low level and you want to go to bed at a low level. What should be happening is in about the first two hours, you should have a huge surge in cortisol. Oh, for the listeners only, Peter is actually, as luck would have it,

there's an easel behind us as we're having this conversation. And he's drawing this out. He's drawing this out. And so you want to have this uptick, gradual down, nice and low at night, and just as you're waking up, it should be just about to kick off. So that's the second factor. So you want adenosine to be high, you want cortisol to be low, and then the third thing

you want is you want melatonin to rise. And melatonin is secreted by this tiny, tiny little gland called the Penial gland, and it is secreted in the absence of light, specifically blue light, and it's basically a signal to tell the brain that it's dark. So it's melatonin basically removes the breaks of staying awake, and that's where the glass is fit in. So if you're really trying to optimize your sleep, you want high adenosine. You can accomplish that by not having caffeine and by being active.

You want low cortisol. That's probably a lengthier topic in and of itself. And then you want high levels or rising levels of melatonin. So we got a bunch of questions around sleep. So while we're on the topic, maybe we can cover a few more. One of the questions was how to minimize jet lag and sleep disruption while traveling. Hey everyone, hope you enjoyed a sneak peek of this AMA. AMAs, along with extensive show notes and member-only discounts on products that I think

are awesome, are available to subscribers only. So if you're interested in hearing the remainder of this AMA or want to access any other benefits that come with being a subscriber, please head over to peteratiamd.com forward slash subscribe to learn more and sign up. If you're already a member, please head over to the show notes page where you'll be able to finish listening via audio or watch the rest of this AMA on video. You can find all of this information and more at peteratiamd.com forward slash podcast. There you'll find the show notes, readings, and links related to this episode. You can also find my blog at peteratiamd.com.

Maybe the simplest thing to do is to sign up for my subjectively non-lame once a week email where I'll update you on what I've been up to, the most interesting papers I've read, and all things related to longevity, science, performance, sleep, et cetera. On social, you can find me on Twitter, Instagram, and Facebook, all with the ID, Peter, ATF, MD. But usually Twitter is the best way to reach me to share your questions and comments. Now for the obligatory disclaim.

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