#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

Foreign. Hey everyone. Welcome to the Peter Attia Drive. I'm your host, Peter Attia. 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@peterattiamd.com. Welcome to this episode of the Drive. This is sort of a cross between what I would call an AMA and a show and tell. I think it's billed as an ama and we certainly do our best to kind of answer all the questions about this particular thing. But it was also a little bit of a, as I say, a show and tell where I kind of go over in detail what this fasting protocol was all about. So this particular episode is very specifically about questions that folks have asked around why I did this, for lack of a better description, this week of keto, followed by a week of fasting, followed by a week of keto. I call it the KFK sandwich, but Bob has referred to it as the Nothing Burger, which probably makes more sense. So this was again, kind of a first for us where we were kind of just spending a bit of time talking very specifically about this experiment I've done. And when I say experiment, I use that term pretty loosely. I mean quotes, self, experiment, maybe n of one nonsense, whatever you want to call it. But hopefully I provide at least some rationale for why this was interesting to me. More importantly, what hypotheses could be generated. And ultimately I think where I'd like to be able to take this sort of insight because my real motivation for doing this, I hope, comes across clearly. This was the first time Bob and I ever didn't record one of these things together. So any other time that we've done sort of interview slash AMA stuff, we're in person. So, you know, this was kind of working out some of the kinks of not sitting in front of each other. But I don't think that really turns into a major hiccup. And then this is going to be one where I think if you don't have the show notes in front of you, you know, at the very least you want to go back and look at them. And the reason is there's just so much data that I end up putting out there. So there's sort of like, here's how body weight changed, here's what my ketone levels were, here's the trailing averages of my blood glucose levels from the cgm, et cetera. And then of course I did a blood test every seven days. So on a three week sandwich, that's basically four parallel sets of blood tests. And there's just a bunch of other stuff. So all of that's going to be laid out in the notes. And so I guess the easiest way to ingest this info would be sort of sitting in front of your whatever device you would read this stuff on and looking at it. Alternatively, you know, I think you can sort of listen to it and then kind of come back and skim the notes and they'll make more sense. So I suspect either one of those will be appropriate. And again, I suspect next time I do some sort of goofy self experiment, we'll continue to do that. That said, we are going to do another ama. We'll record it next month, which will be in September, and by then we hope to have an AMA page on the website. We're in the process of trying to figure out how complicated it is to produce an AMA page of the caliber that I've seen on others like Sam Harris's site. And really like the reason is I think that'll be easier for people than what we're doing now, which is basically people are tweeting us questions, ccing Bob and then he's aggregating them in a spreadsheet. So not that efficient for Bob and not that efficient for you because how are you going to keep track of what questions are being asked, if that matters. So hopefully by September we'll have this new thing up and running. Folks can blast AMA stuff into that and then we can also more efficiently aggregate it and probably tabulate it once people start voting and stuff, giving us a sense of what people like. I think that's about all I want to say going into this. I think the rest of this episode kind of speaks for itself. So I hope you enjoy this discussion about my little fasting experiment. Hey everyone, welcome to a sort of bonus episode AMA discussion, slash, whatever. As some of you may have noted from some social media stuff I was posting, I did a little nutritional experiment kind of recently and a lot of people have asked a lot of really interesting questions and Bob and I figured the easiest way to address it would be to do it sort of as an AMA style where Bob has aggregated a bunch of questions and then he's going to kind of interview me like we did this the first time. And you've probably noticed we are releasing this as a bonus episode, meaning not as a dedicated Monday release podcast. So this will be considered after school education. Bob, where are you today, man?

I'm in my mom's basement.

Right.

I figured that would be. That'd be the perfect place when I'm online. So I'm actually, I'm in Wayland, Massachusetts, which is a suburb of Boston on Skype.

This is our first time not doing one of these things in person. Yikes. All right. Yeah, well, you take it away. You're in charge, Bob. I'm here to answer your questions.

Okay, so a lot of questions came in for the, I guess this bonus episode of AMA for Peter's fast. And Peter, I'll let you explain what exactly you did because I think it's more akin to a nothing burger where you sandwich the fast between two ketogenic diets. And the questions were somewhat far ranging in some ways, but they all kind of centered around what did you do? What were the results, things like that. And also what should I do? And what I thought would be a good idea is to sort of approach this scientifically where we do a little write up of your fasting experiment. And so if you look at most scientific journal papers, they'll have an abstract and they'll go over a little bit of the background and the rationale. They'll talk about the methods or the design of the study, then what happened, which are the results, and then a discussion and conclusions. So I thought that would be a good place to start, really, is the background and rationale. So I would ask what was the point in doing this experiment? If there was a primary objective, it.

Was to save money while I was in New York, which was the week that I was fasting. And normally because food in New York is so expensive, I thought what better way to save money than to not eat anything for the whole seven days I was there. That was the primary objective. The secondary objective was actually to try to work out the kinks on a protocol that I would like to study later on to see if I can, in collaboration with a number of scientists, figure out what a signature of autophagy looks like. So if you have listened to this podcast, you've probably heard me talk about this. I think in particular, we've talked about this a lot on the podcast with Rhonda and probably with Dom, probably even David Sabatini and even a couple of other podcasts that I don't think are out yet where I know we've already pre recorded stuff on autophagy, but basically this idea of eating oneself where in a state of nutrient deprivation the body does something that's evolutionarily quite sound, which says, look, I got to figure out a way to conserve energy here and I also probably ought to start recycling pieces of cellular machinery that are in otherwise maybe suboptimal cells. So it would appear that the greatest way to get into autophagy is to completely restrict all nutrients, that is a water only fast. Obviously there are other things that might stimulate autophagy. Exercise probably does to some extent. Certainly the use of rapamycin likely does, depending on how it's administered. But to really develop a signature for autophagy, to be able to draw a blood test and to look at a series of small molecules, metabolites, proteomic changes, and know that hey, this produced a positive signal in the direction that we want to go that might allow us to have some insight into a question that I certainly don't know the answer to. And I frankly get a little miffed at the frequency with which I see people acting like they know the answer. And the question being what's the optimal fasting protocol? So I think most people realize both scientifically and practically that to just take an individual and constitutively restrict their calories by say 30 or percent or more. One, it's not clear that that actually produces a longevity phenotype in humans in the wild, and two, even if it did, it's not clear you'd want to do it. So it would seem that some amount of cycling nutrient exposure periods of fast and famine are optimal. But I have no idea what that should be. Should that be daily intermittent fasting? Should that be prolonged fasts at some frequency? Should that be a day, a week, not eating? I mean, you could come up with obviously an infinite number of these things and rather than pretend like we know what they are, I'd rather sort of work on developing a tool that we could measure proxies of the benefits of those fasts so that we might once and for all have some way to at least take a more educated approach to this and potentially customize it. Because the other thing to keep in mind is we have no idea if two people would benefit equally from the same fasting protocol. So that was kind of the long winded rationale for this type of an experiment. Now, as to why I chose to do it as a week of ketosis, a week of nothing, a week of Ketosis. And by ketosis I should be clear nutritional ketosis, which will explain what that means versus starvation. Ketosis. That was mostly self preservation. I know from previous attempts at fasting that to go into a fast out of a high carbohydrate state is a little more painful because the body hasn't quite ramped up the process of making ketones. And obviously that becomes the most important thing that's happening when you're in starvation. So that's sort of why I did it. And then as at the front end and at the back end it was actually this is not a scientific reason. It was, I wanted to ward against, guard against the risk that I was going to go ape shit on the refeed and just like go and eat burgers and pizza every day. So I was like, well if I force myself to go into ketosis as I exit this fast, I will at least continue to eat in a reasonable manner. So hence the symmetry and the nothing burger ness.

So we can probably just jump right into the methods of that. Well actually we can't. One thing that I really appreciate when I see this in papers but I don't often do is that typically you'll see table one in a paper where they have the baseline characteristics of the population. What I love seeing is pre baseline. So what is Wild type Peter doing prior to the intervention? Like what is your diet like and your exercise prior to doing this intervention?

So I would say that in the months leading up to this I have been very consistently doing a time restricted feeding window of on the low end maybe 14 to 16 hours of time restriction and on the high end, you know, sort of 20 to 22 hours of time restriction. And I would say six out of seven days a week, if not seven days a week. That's what I was doing. There was not much of a dietary restriction to that other than I was limiting just abject junk most of the time. So when I'm hanging out with Tim Ferriss in Austin, not limiting my junk so much because you know, Tim and I are a really bad influence on each other and we eat a ton of. Although actually Tim is coming to New York today and I texted him last night and I was like, dude, what kind of food do you want in the apartment? And he was so good and so disciplined and he was like, I want veggies, I want protein and I don't want. And then he rattled off all of this bad stuff that we like to eat. So I, we are perfectly set. So basically it was time restricted feeding where I was for the most part not eating junk food, meaning really going out of my way to avoid sucrose and high fructose corn syrup and junky sort of processed, you know, carbohydrates and things like that, like potato chips and stuff. But what I wasn't restricting, and this might be sort of the more relevant question, I wasn't really making any restriction of carbohydrates explicitly and certainly not restricting sort of starches that aren't junk. So I was still eating rice, eating potatoes, eating vegetables ad libitum, and not otherwise making any other particularly interesting restriction. As far as exercise goes, as I've, I think I've talked about this before, I don't train anymore. I haven't trained in three and a half years for anything, anything athletic, that is. So I just exercise now. And what that means is Monday, Wednesday, Friday, I lift weights and the other four days I'm doing something aerobic, slash anaerobic. And it usually involves either the wahoo kicker or the peloton.

Okay. A couple of other components, sleep and stress and actually supplements and medications too. Sleep, you probably, you do have data. Stress might be a little bit more squishy prior to the intervention, but can you comment on those things?

Yeah. So sleep. I use an aura ring, which people have probably heard me talk about a lot of, and I wear it almost every single night. If I am not wearing it, it's because I put it on the charger and forgot to put it on before bed. So I have lots of aura data. I am generally a guy who's going to get seven to seven and a half hours of sleep a night. That doesn't mean time in bed, that means actual sleep time. My efficiency is good, meaning I have low latency time and infrequent wake ups. So if I'm in bed for 7 hours and 45 minutes, I'm pretty much guaranteed to get 7:15 in ish of sleep. As people who use the OURA ring will know. You get a sleep score, which is, you know, kind of interesting. But I like to kind of look at the actual numbers. And the OURA ring using an algorithm based on the inputs that it measures estimates the time you're spending in stage one and stage two sleep, which are known as sort of light sleep, and then stage three and stage four or delta wave sleep known as deep sleep and then REM sleep. Obviously they're not measuring eye movement, so of course these are estimates. I would say that historically I tend to be a little light on the heavy and Heavy on the light, meaning my delta wave sleep, stage three, stage four, generally fall lower than what we would ideally want to see if I were doing, you know, an EEG based sleep study. It's not clear how much of that is an artifact of the algorithm or if it is true because I have not, not done a formal sleep study with the oura ring on simultaneously. That is something I have on my to do list and I just haven't mobilized to do it. But nevertheless, this will become relevant when we get to the experiment because as I'll discuss, one of the most interesting changes I observed was the change in my sleep. As far as stress goes, I would say I was under sort of baseline stress, which is to say probably higher than maybe the average person. But you know, luckily I'm not the President of the United States or the CEO of a major company. So, you know, I guess it's all relative. I was, however, in a pretty good meditative spot, and I've been in a pretty good meditative spot for about the past six months, which means I've been in a really good consistent routine of mindfulness meditation. And I actually did something quantitative two weeks before the fast, which is a. I did what's called a Dutch test, which is a test that looks at urine, dried urine, and measures cortisol and cortisol metabolites. Because I actually felt I was sort of hypercorticolemic. And at least on the two days that I did that test, I was not. And I think it's too elaborate to post those results here because it would take a day to explain how that test works. But I did not appear to have hypercorticolemia based on that test. I had kind of low adrenal, lowish total adrenal output, but totally normal levels of free cortisol, which is actually what matters.

Okay. I'm sure you're going to get plenty of comments about being elaborate on that Dutch test at some point. I'd love to see you geek out on that.

Yeah, I mean, at some point we will. I mean, the biggest thing that one should take away from really, if you want to understand the adrenal thing, is people talk about this idea of adrenal fatigue and they throw that term around a lot. It's a real misnomer. It is almost unheard of to actually see clinical adrenal fatigue. I've probably seen it twice in my life. Meaning patients whose adrenal glands are so dysfunctional that you actually have to give them steroids, corticosteroids, so you can, you can measure how much adrenal output is being produced, but to do that, you can't look at cortisol because cortisol or its inactive sister, cortisone, represent a fraction of the total adrenal output. You have to instead look at cortisol metabolites like tetrahydrocortisone. Tetrahydrocortisone, to truly measure that. And that's why as, as cumbersome as the Dutch test is, it's really the only way that I'm aware of that we can measure these things. So, yeah, we'll, we'll park that as kind of an interesting little back burner discussion.

Okay, supplements.

God, if I could remember them all. And again, which is not to say I take that many things. What do I take? You know, I take vitamin D. I take methylfolate, methyl B12, I take an over the counter dose of lithium. Okay, caveat here. I'm happy to tell what supplements I take. I have zero interest in going through a lengthy justification of them all at this point in time. So maybe in like, you know, the future, we could do a much longer deep dive into how I determine which supplements I take and which supplements my patients take. And by the way, I don't think I have a single patient taking exactly what I'm taking. In fact, I might not have any two patients taking exactly the same thing. So with that said, I think I also take a few other things. I take EPA and dha. I take, I take selenium. I take. I don't know why I'm spacing on this. I load that silly pillbox every single Sunday. I think I just do it by sort of rote. Oh, I take a baby aspirin. I think I probably take a couple of other things that I just can't remember at the moment. There was no change in any supplement or medication that I took during, you know, the months leading up to this or throughout this experience. And sometimes I do get asked that question, which is, hey, oh, I take. You know, so this is not a supplement, but I take metformin. I've been pretty vocal about the fact that I take metformin. I've been taking it for probably eight years. I had contemplated stopping the metformin during the fast. It seemed a little counterproductive to inhibit hepatic glucose output when you were fasting. But I also realized I didn't want to create any artifact. And I wasn't obviously concerned about having hypoglycemia as a response to metformin. So there. I think the more important takeaway here is there were no changes in anything pre or post.

Okay. And we could, let's see, we could jump into the methodology of the ketogenic diet in week one.

Oh, there's one other thing to point out here. In an ideal world, I would have done this entire experience in one place and got DEXA scans at the beginning and through. Like, basically, I would have got four DEXA scans right the. On, you know, the beginning and end of each week. It's not clear that DEXA scans spaced seven days apart, even under the conditions as extreme as this would produce enough signal to differentiate one from the other. Because as much DEXA scanning as I've done, I have not done them in that type of a succession. However, I know enough about DEXA to know that if you're not doing it on the same machine with the same operator over short periods of time, you're very likely to have artifacts of methodology. So instead, I opted for something a lot cheesier. But I was very interested in knowing how much muscle mass I was going to lose. So what I did was I took photos seven days apart and I linked to those in the spreadsheet or we'll. We'll figure out a way to show that. Now, again, I feel like a total douchebag taking shirtless pictures of myself because it's. It's funny when you're the fat guy doing it. It's not funny when you're not the fat guy doing it. But if nothing else, I, I would say it was just kind of a very zeroth order way to assess. Hey, was I like, hemorrhaging muscle throughout this experience? Which would certainly be one hypothesis I'd want to test. And, and although we didn't state it explicitly, I did not make any change in my. At least I did not make any attempted change in my exercise routine. In other words, the objective was to continue exercising identical to, identically to how I did or how I do in my regular sort of feeding window.

Okay. And people can just go to your Instagram account for those selfies.

No, no, no, no, no, no, no.

We'll.

We'll put them in here. Yeah, they're not going to go on Instagram. I'll never hear the end of that.

I thought you did them in real time. Okay.

No, I took them in real time, but I never posted them. I'm saying we'll, we'll link to them within the notes of this as part of the data. Like the. Here are the Pre labs. Here's the goofy pre photo.

Blah, blah, blah, blah. Got it. Okay. Okay.

You think Olivia would give me one bit of slack if she knew I was posting goofy pictures of myself like that on Instagram 00?

Yeah. No. No slack. So how about we go. We can go over your. The baseline labs that you took so we can kind of go through what you're looking at here.

So what I wanted to do was just sort of display some of the main labs I looked at. I did check a bunch of other things, but I also realized, like, I'm not, you know, just for the sake of being lazy, I just wanted to kind of post what I thought were the most interesting things. So at baseline, which was on June 21, this is basically following about six months of time restricted feeding, restricting sugar but not carbohydrates. You see a total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride, non HDL cholesterol, and VLDL cholesterol. So those are what we would call a very standard lipid panel, for what it's worth. The LDL cholesterol is a direct, not a calculated. Beneath that you have the NMR results. That's the LDL particle, the small LDL particle, the small or small dense LDL cholesterol, the HDL particle. And then beneath that you have some markers of oxidation and inflammation, so fibrinogen and C reactive protein, along with an ox. An assay for oxidized ldl. Beneath that, you have some metabolic markers that I pay great attention to, like uric acid, homocysteine. I included blood urea nitrogen or bun, as a proxy for how much protein was probably in my diet. BUN is a really, really poor man's sort of nitrogen balance assay. And then I included cortisol. But it is really important to understand that that's almost a useless number because that is measuring total cortisol in the plasma. Cortisol is about 97ish percent bound to albumin and cortisol binding protein. And it's really only the free cortisol that is metabolically relevant or endocrinologically active. And so when you see at my baseline that my total cortisol was 16.6, I mean, I'm mostly interested in understanding that as a function of, you know, change and not, you know, trying to actually draw any conclusions. Again, it's also a spot in time. These blood tests were all at about the same time during the day, just to say, kind of first thing in the morning on Whatever the respective day was. I realize that some of you are going to look at this and think, what are the reference ranges on these things? I don't care about reference ranges because I have my own. So instead what I've done is I've sort of highlighted things in red that are way off the mark. Then we get into markers of insulin resistance and or adipocyte function. So leptin levels. So I guess we're not going to talk much about leptin levels because they didn't really change at all throughout this experiment. Same with adiponectin. I think for the sake of time, we'll ignore what that is. Obviously fasting insulin level and free fatty acid. I measured, I forgot to measure it one of the days for some reason. I look at iron and some metrics around that. And then I look at hormones, specifically thyroid hormone, which I suspected might be interesting, and sex hormones, which turned out to be kind of interesting as well, though I wouldn't have predicted this necessarily. And then I just look at some metrics like white blood cell count, hematocrit, hemoglobin, platelets. So all of that stuff is kind of listed. And you'll then see four of these numbers going from the baseline to the following a week of ketosis, to following the week of fasting, to following the week of ketosis.

Okay. And then you also had some more basic markers. You looked at, for example, your weight and your. Was it beta hydroxybutyrate? I think you're testing pretty frequently.

Yeah, thanks for reminding me of that. So starting on whatever day that was, July 8th, so the baseline labs were done like whatever two weeks before I started, but I started the whole shtick on July 8th. So my weight that morning was 184.6 pounds. I didn't measure BHB because I knew it was going to be low. I wasn't in ketosis, so I didn't feel like wasting a strip. And then I looked at a 90 day trailing CGM. So I use the Dexcom G6. I'm pretty much always wearing it, even though obviously you change it out every 10 days. And I just look, you can generate reports. What's my trailing? 7 day, 14 day, 21 day, 30 day, 60 day and 90 day blood glucose. And so my trailing 90 day blood glucose was 99 milligrams per deciliter with a standard deviation of 15. Now that's a little bit higher than I would like to be. Truthfully, if someone, some people may remember, I've talked about this in the past, I, I think sort of 85 to 90 for an average blood glucose is the sweet spot. So a trailing 90 day blood glucose of 99 milligrams per deciliter places you at about a hemoglobin A1C of 5.0, if I recall. Let me. Can I look this up right now, Bob? Am I allowed to putz around here?

I'll allow it.

A 1C. Yeah. That would be about 5.0 to 5. It's about halfway between 5.0 and 5.1. So again, I think for me that's a little on the higher side, but. But, you know, sort of reflects me eating carbs. Like my job is eating carbs. The other thing I recorded in this spreadsheet was what the exercise du jour was. So. And I wasn't very specific. So. Please. I mean, not that I don't know what I did on those days, but I don't. I didn't. I was too lazy to write it out. So ride means either I'm on a peloton, on a wahoo kicker, or maybe once in a blue moon actually outside. But these are not like super long workouts. This is like 45 minutes or something, something like that. And the lifts are probably 90 minutes. And then you can see. I would just basically look at AM and PM BHB level. I was using the keta. The. What is it? It's the ketone mojo or keto mojo or something like that. Like the one that I like a heck of a lot better than the precision extra. Yeah. So during that week of ketosis, you'll see, obviously weight starts to go down. Ketones, finally, you know, they start to show up and then you can sort of follow what happens. So I think I've color coded this spreadsheet such that green. The green background is the first week of ketosis, the yellow background is the week of fasting, and then the green background is the other week of ketosis on the back end. Cool.

Okay. Are you going to share any of your sleep data? Is there a good way to show that? That might be cool to show.

Yeah. So, yeah, what I should probably do, we should just. We'll figure this out. I'll just take some screenshots of those and show those.

Okay.

You're making more work for me, Bob. I really want to be done with this, man.

Fewer follow up questions probably. At least from the, from the peanut gallery. So let's get into. Do you want to go over all in one shot. Do you want to go over like your baseline labs, what they are, what they were right now, or do you want to just. We'll go through what week one looked like in terms of the methods, week two, week three, and then we can just circle back and go over everything at once where you talk about your baseline numbers and all the follow ups. Or do you want to.

Good question. I wish we could ask people live what they would prefer. I think it might be easiest to just go through what happened after week one, through all the issues, then week two, at three, et cetera. So with that said, and again, I think this is one of those podcast where it's going to make a lot more sense if you're looking at the data. Because I don't really think it's palatable for me to just read off lab after lab after lab, especially for people who aren't, you know, who don't necessarily know what all of these numbers mean. It's just going to seem a little bit sort of overwhelming. But what I would say is, during the first week of getting back in ketosis, what did I notice? So subjectively, having not been in nutritional ketosis for a long time, I definitely felt a tiny bit, not nearly as bad as it was when I first did it in 2011. I felt a tiny bit of the keto flu, as they would call it. I think it's kind of a dumbass term. It doesn't feel anything like the flu. I just felt orthostatic. Every time I stood up, I felt a little bit lightheaded. I supplemented. Oh, that's. Sorry. This is one change. I lied earlier. There is one change I did make in my supplements during this time that goes beyond what I do normally. So normally I take magnesium. See, I forgot to mention that I normally take 400 milligrams of mag oxide and about two slow mag every day. During this period of time, I increased that to eight. I doubled it. Basically 800 of mag oxide and four slow mag tablets. And the reasons for this have been well described. But for the person who might not. When you're in ketosis, your body basically starts wasting sodium. Your body responds by trying to save sodium and usually ends up shunting magnesium and potassium out of the kidney. So you do tend to cramp more. And if you're not supplementing that sodium and magnesium, you can also tend to get a little lightheaded. So I was using bullion as needed during the fast quite regularly. During the ketosis week, not as regularly, but I did double my magnesium. That said, outside of being a little Bit lightheaded upon first standing. I did not experience any change, positive or negative, that I could perceive subjectively in how I felt or performed. So, you know, workouts felt just the same, sleep felt about the same, and, you know, more or less it was just, you know, kind of business as usual. I guess it's probably worth mentioning. What did I do dietarily? I went for a very boring, boring, repetitive ketogenic diet where I was still usually skipping breakfast anyway. Or sometimes I would have, like, maybe an egg or some bacon or something. But usually I didn't have breakfast. I would just have coffee with a bit of MCT powder in it, you know, lunch. I would have some macadamia nuts, maybe an avocado, some olives. And then dinner would usually just be a salad and a modest enough serving of protein that I could be confident I wouldn't boot myself out of ketosis. So you can see baseline cholesterol levels, lipid levels. Now, I do this sort of blood testing on myself pretty frequently, probably about every two to three months. So these baseline levels from June 21st are pretty standard levels for me. You're always going to see perturbations on these things. For the most part. I generally like to see my LDLP lower. Kind of like to be at the 800 nanomole per liter level. This was 920. But again, that's sort of within the ballpark. I like seeing C reactive protein below 1, ideally below 0.5. I like seeing oxidized LDL below 40. I like seeing uric acid below 5, homocysteine below 9. These are some of the metrics that I'm really looking at consistently. Let's see, I was kind of pleasantly surprised that my free testosterone was 15 below nanograms per deciliter. Every time you look at a hormone level, you really have to evaluate it in the context of that lab. So 15.5 nanograms per deciliter on this lab represents almost exactly the 50th percentile. It might be the 55th percentile. So that's an important reference point. As we go through this experiment, you'll see how that changes. The other thing to notice is my thyroid labs at a baseline, they look really, really about as normal as they can be. So a discussion of thyroid endocrine systems is way beyond the scope of what we want to talk about today if we're going to finish in time. But you basically, by looking at TSH, free T3, free T4, reverse T3, and the ratio of free T3 to reverse T3, you can kind of infer a lot about what's going on with the enzymes that are called diodeinases that turn T4 into either T3 or reverse T3. So at the risk of explaining nothing but just giving you the punchline, you want to see your TSH kind of below 2ish, and that tells you that your brain is adequately seeing T4 converted into T3. You want to see your ratio of free T3 to reverse T3 above 0.2. As a general rule, that tells you that the balance of T4 being converted into the active hormone T3 is in favor of T3 over reverse T3, which antagonizes T3. So as that ratio goes down and gets down below 0.2, it suggests that the body is in some way compensating and wanting to reduce thyroid activity. So the common reasons that we see reverse T3 go up and. Or reverse free T3 go down, but in particular this ratio go down, is things like post obesity. So in people who have lost a lot of weight, insulin resistance, leptin resistance, infection, inflammation, sleep deprivation, hypercortisolemia, There are a number of things that can basically alter that thyroid axis. So at a baseline, my TSH was 2.4. Yeah, usually is a little bit lower than that, but I'm happy. My reverse T3 was 11. Great. My free T3 3.7. My ratio 0.34. So feeling like a thyroid champ. I think those are kind of the interesting. I mean, the rest of it, I think people can just read and get a sense of. Like, at baseline, I looked, you know, I was an 8 out of 10 at baseline relative to my standards. Okay, so what happened after a week of ketogenic diet? Virtually no change whatsoever in my standard lipid panel other than, interestingly, my triglycerides went up, which is, you know, kind of unusual. When you're on ketosis, typically your trigs go down. Mine actually went up from 54 to 90 milligrams per deciliter. It's important not to read too much into triglycerides and things like that because they. They can certainly vary from day to day and. And be a function of. Of, you know, what was going on in a previous meal or something like that. But otherwise, if you look at total cholesterol and LDL cholesterol, they were virtually unchanged. Interestingly, my LDL particle number went way up. And that, to me, represents a real movement going from 920 to 1380. So that represents going from about the 10th percentile of the Mesa population to about the 55th percentile of the MESA population, which is way higher than someone like me wants to be. Also, my small particle, where I really like to see that below 500, that went up to almost 800. By the way, one thing worth noting for people who are also measuring NMR or using NMR is there's basically two ways you can get an NMR done in the United States. One is using LabCorp. The other is using THD. Really important to know they're using different magnets, basically, and the THD numbers, which are believed to be more accurate, run considerably higher. So LabCorp is using an NMR developed by Liposcience on the first generation magnet. THD is using the NMR also developed by Liposcience, but they're on a second generation magnet. And I have scrutinized these results side by side because on a number of our patients, we do them side by side. And I've looked at all of the data, and as a general rule, if you do a parallel NMR with liposcience through what is now LabCorp versus THD, the THD numbers tend to run about 20% higher. No real change in my oxidative numbers, but I was very interested to see that my uric acid bumped from 4.8 to 6. Six is, again, depends how you define high. I think most doctors would not consider a uric acid of 6 particularly high. It's not certainly putting you anywhere in the danger zone of having a gout attack the next day. But I'm really maniacal about uric acid being low because of the impact uric acid has on blood pressure and on atherosclerosis. So uric acid. There's some evidence that uric acid can crystallize inside of atherosclerotic plaque along with the sterols that can crystallize there as well. Homocysteine took a bump up to 11. Again, no change in my methylated B vitamin regimen. So that also suggests something funky metabolically was going on this week. Getting back into ketosis. Let's see what else was interesting. Oh, of course, the thyroid stuff, right? So my thyroid took a hit that week, and it wasn't a central hit, meaning my TSH stayed totally reasonable. So my brain didn't think anything was wrong. But my free T3 went down quite a bit from 3.7 to 2.5, and my reverse T3 went up from 11 to 17. So this ratio of free T3 to reverse T3, that was initially great at 0.34 was now kind of in the crapper at 0.15, which if you're going to interpret that, you might say, well, something. There was some force, you know, something in my body was sort of wanting to slow my metabolism down. Now, during that period of time, time I lost a little over four pounds. So I started this whole experiment at 184.6 and I wound up at or at the time of this blood test, which I think was on the 13th, I was 180.4. So I was actually a little surprised to see the deterioration of thyroid function because that doesn't strike me as nearly enough weight to lose, especially when you realize that most of that was water weight for my metabolism to. Or my metabolic rate as it would seem to take a hit. Testosterone actually went up a little bit. It went in total testosterone, which we rarely talk about since again, it's sort of like talking about total cortisol. It's kind of irrelevant. But total testosterone went up from 764 to 920. And free testosterone went up as well, even though sexomor binding globulin went up with testosterone. And so the free Testosterone went from 15.5 to 17.4 nanograms per deciliter. Again, that's not a huge change, but that does put me now at maybe the 60th or even 65th percentile. Also, the IGF did not really take a bow. So started out at 201, which for my age is about. And on this assay is about 80th percentile, which is, I think, actually the sweet spot. 70th to 80th percentile. I think it's a sweet spot down to 196, which is effectively no change whatsoever. That's within the margin of error. So a week on a ketogenic diet did not seem to lower igf, which is interesting because I know that when I'd been on a ketogenic diet in the past for long periods of time, my IGF was consistently lower, which might suggest me that a ketogenic diet does lower igf, but it needs more than a week to see the results. And also a discussion on IGF is way more elaborate than I'm going to get into today. But, Bob, you and I have talked a lot about this. I think that the right IGF algorithm is actually cyclic and not just always low or always high, but that's another story. I could go on and on, but I realize we're probably past the point of diminishing returns. So anything else, Bob, that I haven't touched on that you care about? As far as week one, one question.

That I have is with the ketogenic diet. I know you've done prolonged ketogenic diets in the past. And what was your approach for the week? I know that you don't need to necessarily weigh and measure things. You probably eyeball stuff. Did you have a particular target when you say, this is the number of grams of carbohydrates that I'm going to eat a day. This is the number of grams of protein. And then in terms of fat, were you trying to. Was this like a 4 to 1 ketogenic diet or was it something a little bit different?

Great question. Thank you for clarifying that. So unlike when I was in ketosis for the long haul and I was maniacal, meaning I had a spreadsheet of every single thing that I would eat and I would measure out exactly how many grams of X, Y and Z were going into me for this. It was all smoking and joking. So I just, I guess the. Fortunately I've been in ketosis long enough to kind of directionally know like this much protein is too much. This is probably okay. So I made zero effort to focus on whether I was in three to one, two to one, four to one. I didn't care. I just wanted to kick off some ketones. And luckily I was able to sort of get, you know, to consistently be above about 1 millimolar that week. So I. It'd be hard for me to even estimate what I was ingesting, though I would guess probably 30 grams a day of carbs. You know, I think my biggest intake of carb would have been the avocado I had every day and then, you know, the salad and stuff like that. So maybe 40 grams of carbs. Protein was probably a buck 10 to a buck 20 a day. And I wouldn't even be able to guess how much fat intake I had. But I was not in any way, shape or form trying to restrict input.

Okay, how do you think the volume of food compared to like baseline or prior to baseline? Do you think it was about the same? More, Less?

I think I felt like I was eating a little bit less. Again with volume. It's so hard because the shift towards so much higher fat content. But I definitely felt less hungry, which I think anybody who's been on a ketogenic diet realizes is generally a consequence of that. And yeah, there were just times when I was sort of like kind of eat a little bit Just because I was sort of bored and I was like, oh, those. I like the taste of macadamia, so I'm just going to eat some. But if you really push me on this, I'm not that hungry. So if you talk about pure food volume, it was definitely less. But if you mean caloric density, you know, my guess is it was a little bit less.

All right, so week one is complete. And then, so that was seven days, right? Days one through seven you're on the ketogenic diet. And then on day eight, you're now embarking on a water only fast.

I don't know the day number, but it was the day I left San Diego. So there was a Saturday, I think it was July 15th. What the other thing I wanted to do, I should have expressed this at the outset. Part of the reason I did seven days was that's how long I was in New York. And I didn't want to fast at home because I didn't want to kind of weird out my kids. So I. That was the other, you know, because you could ask, well, why didn't you do it for 5 days, why didn't you do it for 10 days? Or whatever? It was like, look, I'm in New York from a Sunday to a Saturday, the entire time from, you know, up to down, I will just not eat. So. And then that way I just didn't have to get into all weird stuff with my kids being like, what's wrong with daddy? So yeah, whatever that Sunday was, I think it's the 15th was the day I just stopped.

Okay.

And then that day I remember I landed in New York and you'll notice there for exercise that day I just went for a five mile walk with a buddy of mine in the park. And that was because normally the day I get to New York, I usually will do a peloton ride that evening. But I for whatever reason just bagged the ride and instead went for a walk with my buddy. And you'll see that night my BHP level was really not particularly high because it had basically just been now like a day of not eating. So it was 1.2 millimolar. And you'll also notice at this point, Bob, I started doing, doing trailing seven day CGM checks. So I gave you my baseline CGM as a trailing 90 day, which is basically my hemoglobin A1C going into this whole shtick. But then it was like we're going to do this every single day and do trailing seven days so that you're getting a Much greater sense of what's happened in the past week. So what you see on the 15th is that my trailing 7 day CGM went slightly down from 99 to 97 milligrams per deciliter, which is about a 110 of a point reduction in hemoglobin A1C. My volatility went down a little bit, so my standard deviation went down from 15 to 11 over that period of time. But from this point on, Bob, I did, I did that trailing seven day every single day. So you'll now be able to see with some clarity what was going on with my glucose levels throughout this. And this obviously is much more insightful than doing finger sticks. The Dexcom G6 is so staggeringly accurate that it does not even require a single calibration. That said, I still did a spot check twice a day. I'd have to go back and look at the data, probably plus or minus 2% with the spot check. And I was spot checking on two devices, the Keto Mojo and the One Touch Ultra. So I'm doing twice day two device calibrations on a machine that doesn't even require a calibration. It's plus or minus 2%. So these of all the numbers here, this the CGM trailing is. You can take that to the bank more than anything else.

Okay, so this should be pretty clear. But water only, fast. Literally no coffee. Nothing but H2O in terms of.

Yeah, I didn't, I, I was super strict. Yeah, no coffee. A couple times I had tea, like a caffeine free, like I'd brew some, some tea. I had bouillon, as I said, a bullion that was basically just sodium. There was no fat in it or anything like that. Because obviously if you have real bone broth or, or similar things, you're going to get some calories. But absolutely no coffee. Which was again, I'm not a coffee addict, but I love me some coffee that was just out of routine and ritual. It was painful to look at my beautiful French press and all of my trimmings and not make coffee every day. And I also didn't chew gum or use or have any sort of artificial sweetener. I mean, obviously I wasn't going to drink a diet Coke or anything, but I also thought that maybe chewing gum would be a slippery slope. So, yeah, it was kind of weird. I think I made this point to you at one point, about three days into the fast, I realized, oh God, I just love brushing my teeth. Like I just love having that toothpaste in my Mouth. I was, like, brushing my teeth three times a day, and just like. And even after I finish, I wouldn't spit the toothpaste out. So I try to walk around the apartment for, like, five minutes with the toothpaste in my mouth just to get the taste.

I can understand why you didn't want to do this.

Sounds pathetic.

Yeah, I can understand why you didn't want to do this in San Diego and weird out your kids. So do you want to go over the labs after the days of fasting and we can circle back around on the subjective stuff?

Yeah, we'll circle back to kind of the other stuff. Yeah. So after the week of fasting, my lipids did actually change, both at the standard lipid level, but also at the particle level. The total cholesterol went down, and I think that's a real drop. It went from about a buck 20-90mg per deciliter. The LDL plummeted to 37mg per deciliter. I don't think I've ever seen a number that low. The HDL cholesterol went down with it. The trigs actually remained surprisingly high. 76 milligrams per deciliter. Again, we generally like to see triglycerides below 100, but I was sort of surprised that they weren't lower. And also I was kind of surprised that the VLDL cholesterol wasn't a bit lower. The LDL particle number did go down a little bit, probably to more what I think my baseline is, which is about 800, and the small particles sort of returned to what I think my baseline is. Interestingly, the cholesterol content of the small LDL particle fell to quite low levels, which is nice. That's a, you know, that's sort of a marker we care a lot about. And the HDL particle number also went down quite a bit. The inflammatory numbers got, you know, as good as they get, typically, so very low. Fibrinogen CRP. This is a very sensitive assay. So 0.4 is pretty low. And an ox LDL of 31 is righteous, as the kids would say. Uric acid just skyrocketed 8.0. I was like, wow, that is something else again. Now you're actually getting to a point where, you know, if you get uric acid too much higher than that, you actually are running the risk of having a gout attack. And you could certainly say that. Well, and to be honest with you, I actually. I have some speculations on why that happened, but I actually need to reach out to Rick Johnson, who's the world's expert on uric acid, to pick his brain on this, because I think he would have much more interesting assessment. I mean, I'll give you what my very crude assessment is. My crude assessment is there's probably some muscle breakdown and it was effectively just you're seeing an increase in DNA turnover and you're seeing, you know, pyramidines, pyrimidines, etcetera, Going up. And those things as a byproduct will generate more uric acid. So we know what it wasn't, right? It was not an increase in fructose consumption, it was not an increase in ethanol consumption, and it was not an increase in exogenous protein consumption. Those are the three things that far and away drive uric acid more than anything else. So my only explanation is there's just a huge turnover of DNA and the backbone of DNA is one of the things that, when it's broken down, leads to this byproduct of uric acid. In fact, it made me wonder if could uric acid levels or changes in uric acid level levels be a small part of the signature of autophagy we might be interested in? And the reason I don't think it's just dysfunctioning metabolism is the homocysteine went back down. You see, if the homocysteine had gone from 11 to 14, I'd say, Ah, something's wrong there. But the homocysteine actually corrected. And yet the uric acid went to a level that I've never seen before in myself. So kind of interesting. The blood urea nitrogen went down to 12, which, again, that makes sense in the context of there's no protein coming in. I was at best in a neutral nitrogen balance, but almost assuredly was in a negative nitrogen balance, meaning that I was losing. I was, I was losing nitrogen or losing nitrogen from within my system because I was not taking in enough protein. You know, leptin can't get lower than where it is. Adiponectin didn't go up. I'll tell you, this actually really surprised me. So adiponectin is, as its name suggests, an adipokine or a fat cell or adipocyte derived. And it usually rises as lipolysis rises. So as fat cells turn over fat more, we usually see adiponectin go up. I was very surprised to see no change in adiponectin, despite the fact that my insulin levels at this point were unmeasurable and my free fatty acid levels were Very, very high. Both of those things you would expect after not eating for a week. Insulin should be unmeasurable. And as evidenced by the fact that I was making ketones like, you know, my life depended on it, which it was, my free fatty acid levels were quite high. The other thing you'll notice if you're going through this is my ferritin went up. And ferritin itself is also an acute phase reactant. I didn't discuss this earlier. Most people think of ferritin through the lens of only iron displacement, but it's also an interesting marker of inflammation. And we did see a little bit of a bump in ferritin. It basically doubled, though it was still within what we would call the normal range. And then to me, the most interesting was the complete and utter destruction of my thyroid function peripherally. So centrally, no issues whatsoever. TSH actually went down a little bit more to 1.34. But in I don't know how many years and how many patients labs I have looked at, I have never seen thyroid numbers this bad. Free T3 down to 1.8 and reverse T3 up to 38 for a ratio a free T3 to reverse T3 of 0.05. Keep in mind, anything below 0.2 is generally consistent with, you know, hypothyroidism in the periphery, with which generally produces symptoms. And as we'll talk about when we get to symptoms, I was certainly experiencing at least one of them, which was I was incredibly cold most of the time. Again, the best explanation for this is the body basically said, hey, dude, don't want you losing any more weight than you're going to. We are going to shut down your metabolic rate. And I think if you look at the trajectory of my weight loss, I suspect it's actually quite consistent. Consistent with that. I don't think I lost nearly as much weight as one would expect. Again, when you consider how much of the weight I lost was probably water. My sex hormones also took a little bit of a nosedive. So without any change in dhea, I just stopped making testosterone. How do I know that? Well, I know that because my luteinizing hormone and my follicle stimulating hormone, which are very consistently around seven and three respectively, went down to about four, four and a half and two and a half. And along with it, my testosterone went down from 920 where it was previously to 539. But again, more importantly, the free testosterone went down from 17.4 to 7.8 nanograms per deciliter. Now, placing me at about the 15th percentile. So yeah, I got more testosterone than a 13 year old girl, but not by a lot. I'm being a bit facetious. I have a lot more than a 13 year old girl, but being at the 15th percentile still sucks. Now you also saw the huge hit on IGF, so IGF down to 93. That's about the 10th percentile for my age. And interestingly, the hematocrit and the hemoglobin went down. And this is interesting for a couple of reasons. If anything, I would have been a little bit dehydrated during this period of time, although not necessarily. And certainly the fact that my platelet count and my white blood cell count didn't change would suggest that this wasn't a dilution effect, but rather an actual reduction in production. And that makes sense in the context of testosterone. Testosterone is a very potent signal to tell your bone marrow to make red blood cells. Obviously not as potent as epo, which is a naturally occurring hormone that does that. But as testosterone goes down, we sort of see my hemoglobin, hematocrit go down. Good thing that that week I was not in the tour. I would not have done well Mr. 40, nor would I have done well anytime but Mr. 40.

Mr. 43. Yeah. Okay, so that's fasting.

Yeah. Okay. So then. Oh, the other thing, I mean, I guess we'll get to, I don't know, we talk about exercise and the subjective stuff later. So I guess we'll just finish up with the lab since it's the least interesting stuff, I guess. Or not the least interesting, but just the most boring to talk about. So then coming out of, so, so I nad at 175. So if you're keeping track from the beginning, I was at 184.6. You'll actually see my weight rebounded a little bit. So the first morning after the start of the fast, I was 182.4. I was actually heavier than I was three days earlier. I, I thought at the time it might be that I was overdoing it on the bullion, which would make sense. Putting, you know, pounding down water and sodium would actually pack on more, you know, mass. But then the weight started to kind of come off a little bit. And so by that last day I was down to 174 pounds, which was a 10, a little over 10 pounds down from two weeks earlier and probably about 8 pounds down during the period of the fast. And truthfully, I would have expected a greater weight loss when I had previously done like five day FMDs where you're taking about 750kcal per day. I would easily lose 10 pounds during that five day period. So a little surprised. I think the most interesting thing here obviously is the ketones now all of a sudden get to be much higher levels. These weren't even my highest levels sometimes, but these were the ones that I was always checking first thing in the morning and last thing at night. Sometimes during the day I would do spot checks and have even higher levels, but I don't think I, I think I only once got above 7 millimolar on BHB. The other thing you'll notice is how quickly that 7 day trailing average CGM starts to go down such that by the last day of the fast it's 79 milligrams per deciliter. So it's fallen almost 20 milligrams per deciliter in average during that period of time. And again, that just reflects the fact that you're, you're going to, you're going to find an equilibrium pretty quickly. And I suspect had I gone on even longer it probably would have centered out at about, I would guess around 70. So with that said, we go into the last, we go into the refeed week and then we can be done with labs.

Yeah.

All right, so refed on a ketogenic diet. Although in truth the actual day I refed my first meal was probably a little higher in carbs and vegetables, meaning starchy carbs and some veggies than normal. But I had enough ketones floating around that it didn't seem to matter. I still sort of stayed in ketosis. And so then I just go back into a straight up ketogenic diet. Okay, so then these labs here, there, there are a couple things that surprised me. The first was in all of the crazy ass feeding experiments I've done in myself, I have only once seen a very elevated triglyceride level in myself. And this was one of them. So I remember drawing this blood on myself and after I. So the way it works is you're drawing a tube of blood. Each tube has a different protocol. So some of them you have to let them clot for a while, others you spin them right away, etc. But the, once I spun the tubes down, I knew the triglycerides, or at least I suspected the triglycerides were very high because of how cloudy the serum looked. So when you, when you take blood and you spin it, you're basically taking all the cellular Content, the red blood cells, the white blood cells, the clotting factors, and you're putting them in the bottom of the tube, and then there's usually a little serum separator gel in the middle, and then above that you have this clear ish plasma. But it was actually foggy, so I was like, that's weird. It was a fasting blood draw. So I wasn't that surprised to see that the triglycerides were so elevated when I came back. Except for the fact that I was surprised that my triglycerides were so elevated when I got the blood test back. I don't know what to make of it. I think it's also interesting that my LDLP had never been lower. So after that week of being on a ketogenic diet, surprisingly, my LDLP went down to 516 and the small LDLP were unmeasurable. Again, kind of an unusual thing to see, and I don't know what to make of it. I'll probably get around to rechecking my blood in another couple of weeks, and I would be shocked if I wasn't sort of more back to where I was in June. But I haven't really come up with a great explanation for why on that ketogenic diet my ldlp, which normally goes up a little bit on a ketogenic diet, would go so low and why those trigs would go so high. You'll also see my CRP actually got up above 1, which I don't like to see, and I don't know what to make of that. The only thing I can think of, and this could be a totally nonsense explanation, even by my standards, I was consuming a ton of dairy in that last week on ketosis in the form of heavy cream. So I kept making whipped cream out of heavy cream, and I was eating it by the truckload. So who knows, maybe at some point just enough dairy is going to bump your crp. Nice to see that the uric acid and the homocysteine returned right back to normal. And even though my thyroid function was still a little out of sorts, it was moving back in the right direction. So the free T3 went up from 1.8 to 2.9. The reverse T3 from 38 down to 14, the ratio 0.21, and I made a little bit of a gonadal comeback. So the LH back up to 7, the FSH down to 3, testosterone up to 8 and change, and the free testosterone back to 13.3, just a little bit below the 50th percentile, but not that far, far off from the 15.5 I started at. And with it, for what it's worth, hemoglobin, hematocrit started to move back to.

The baseline direction on the ldlp. Let's see.

Bob, you didn't even make a comment about my gonadal comeback. I thought you would appreciate that.

Stupid.

That was an on the spot like little joke.

I'm laughing off mic, I think, trying not to interrupt. I do like that. The ldl. So let's see your numbers. The small LDL P. Is it possible that it's. I don't, I don't want to say an artifact, but maybe it's trailing more. So you did five days of fasting and then you did a. Or, sorry, six or seven days of fasting, you did a, you took a draw then. And then seven days later you took another draw. But if, maybe it's possible that it's, it's almost trailing a little bit more. Do you know what I mean? With the, with the particles?

Yeah, I don't think so, given how short their half lives are. You know, the ldl, low density lipoproteins, you know, half life is like about a day, maybe closer to two days. Not what is commonly discussed is two to four days. That's incorrect. The residence time might exceed that, might be at that level, total residence time, but not the half life. So I don't know. I think we're getting pretty quick feedback on those particles. Actually the HDL particle is the longest surviving. That could be six days, five days easily. So there might be a little bit of lag time in HDLP. But you'll notice, look at the big rebound in HDLP 35.1. So yeah, I'm not sure. Again, I don't. The good news is I'm going to be doing this kind of nonsense a lot. So you know, one has to be very careful about not over interpreting a bunch of NPC of one nonsense, which is all this is. Let's not lose sight of that.

Yeah, CRP too. I don't know what you did for. I mean I think you might have lift and then no exercise. But I think exercise, just an acute bout of exercise, like hard exercise, can probably raise that CRP too. It's a possibility.

Possible. So what day was that blood draw? So that blood draw was on the 27th. So I did it the morning of a lift, the morning before I lifted, but I hadn't exercised the day before. Yeah, I don't know. I don't know that. I don't know that I could say hard exercise would have been the answer either because I had a full day off before.

Okay, one other speculative thing on the sex hormones, your cholesterol, so the six days after fasting in particular, like your, your LDL C, just the standard lab measurement, you're not quite like a hypo functioning PCSK9 mutant, but you're pretty darn low on your LDL C. And I'm wondering if, can it be part of the idea that cholesterol is used for hormone synthesis, that if that's going down a lot, maybe the sex hormones are taking a hit on that?

You know, it's funny, I realize that that's a popular thought. I don't think that's the explanation. In other words, I don't think that cholesterol shortage is the, is the explanation. And for the following reason. When you see my total cholesterol of 90 milligrams per deciliter, my LDL cholesterol of 37, my HDL cholesterol of 35, that doesn't give you, me or anybody else even the slightest iota of how much cholesterol exists within the cells. In particular my Leydig cells, the cells that make testosterone. So, you know, it's a little bit like looking at the volume of water in the ocean. It's a little bit more, it's a little bit less. The icebergs are melting, they're not melting. And trying to infer how much water is on the, the steam liner rolling through the ocean that they use to make coffee and tea, it's very difficult. I mean, how could you even do that? Right? So I don't think that's the explanation. I suspect, and I'll tell you another reason why I don't think that's the explanation. Look at my DHEA level. I mean, DHEA is the precursor hormone. It actually went up. So it's not like my body didn't have the substrate to make testosterone. It actually had slightly more of it. In fact, the following week it went from 230. The DHEA went from 230 down to 180. And the LH and FSH rose. The body responded, made the testosterone. So no, I don't think this was a substrate driven issue, which is not to say I have an answer to what it was, but I don't think it was substrate issue.

I do think the thyroid, where you mentioned this guy, doesn't need to lose, you know, talking about yourself, doesn't need to lose Much more weight here. There's nothing coming in and there's sort of, there's a preservation going on with the thyroid. I'm wondering if the same thing happens with the sex hormones as well, that you're not exactly focused on reproducing, you're focused on survival at that point, you know, a week later.

See to me that's, to me that's a more logical hypothesis that makes more sense than I ran out of cholesterol. I think it's much more in line with when you're starving. I want you to have a little less interest in getting laid and a little more interest in getting food. I mean the risk of just sounding a little crude. Right?

Yeah.

Like if that to me kind of makes more sense.

Yeah, I remember that paper you mentioned, I think with Dom d', Agostino, Craig Thompson, Matthew Vanderheiden and Luke Cantle, where there's a comment in that article that always. That stuck with me and they were talking about, basically they're talking in the context of cancer, but they're saying you always more or less you have an excess of energy outside of the cells. It's a matter of the receptors or something basically telling the cell to take it up. And in this case I'm wondering if there's something to that effect as well. That it's not necessarily that you have like a. It's not that you're deficient in cholesterol or that you have a deficiency per se. It's that the receptors or something basically is getting down, regulated.

Agreed. I think, yeah, I mean I just agree full stop. The system is more complicated than just we've run out of the precursor. Like there just doesn't strike me as a way that it's reasonable that a molecule as vital as cholesterol could ever get to the point where like we, we allow ourselves to become rate limited under, especially under a situation of fasting or something like that. It doesn't make any sense.

So let's, when we move into the subjective results.

Yeah. So I mean I think there were a number of things that stood out to me and obviously I'm just going to mainly talk about the week of the actual fast. I think the, the bread, so to speak, on the nothing burger is not that interesting. So the first thing that interested me, I only had one concern going into this week of fasting which was every time I do those 5 day FMDs, sleep just drives me nuts. I hate going to bed so hungry and when you're like eating 750 calories a day. You're generally going to bed hungry. And I generally find it quite miserable. So that's the one thing that kind of was a bit of a. I was kind of dreading. I was like, you know, I'm gonna be in New York. I'm gonna be working my ass off. And I don't like the idea that every night I'm gonna lay in bed staring at the ceiling for 10 hours, starving, wishing I could eat the sheets. And even though I didn't think it would last the whole week because I knew at some point the ketones would sort of kick in, even just having to do that for two or three nights was a little unpleasant to me. And yet immediately from the very first night, that Sunday night, I was hungry because I hadn't eaten all day. I mean, I slept like a champ. There was just such an improvement in my sleep, not in the duration, actually. I generally sleep a little bit shorter when I'm in New York. Part of it's the jet lag, but part of it's just the noise and the stimulation, and I'm a lot busier. But I woke up the next morning and I was like. I felt like. I felt like I'd slept 10 hours. Even though I'd probably slept, I'd have to go back and look. But it might have been six and a half or something like that, or seven. But my stage three, stage four numbers, which are typically the lowest numbers, were surprisingly high, about 2 to 3x what they normally are. And that just continued without exception for that entire week. And it abated the second I refed. So, I mean, we can explore that a little bit more. But that was sort of the most surprising, quasi subjective, quasi objective finding. I think the second thing that really kind of surprised me was how strong I felt when I was lifting weights. So I did not experience any. Any deterioration of strength. And it. It actually got a little bit better by the end of the week. That Friday, which was day six, which was a squat row press day, that's a very heavy day. I mean, I felt like a beast now. I was lightheaded every time I would finish a set, especially squatting, I thought I was going to fall over. And I think I held off a little bit. I probably stayed about 20 pounds below maybe where I would have gone otherwise on that day. But, I mean, absolutely no deterioration of strength whatsoever. Conversely, I felt. Felt impossible to move my legs quickly. So walking felt super unpleasant. On day three or four, I went for a walk in the park with a friend. Of mine. And we were going to walk the loop of the park, which is about five or six miles. And halfway through, he could just see how much I was dragging my ass. And he's like, dude, let's just. Let's just cut across here and cut it short. And I was. I didn't argue. I was like, okay. Also, riding the peloton was super painful. Just couldn't generate the cadence. Couldn't keep the cadence above 90, you know, in the 90 to 100 zone where I would normally like to be. And actually, it's funny, I'm embarrassed to say this, but on that Friday, the day six, after I finished having a great workout of squats and, you know, rows and all of these, you know, heavy compound movements, I. The thought of walking the mile home from the crunch to my apartment was so unbearable, even though it was a perfectly nice day, I took a taxi. Never done that before in my life. Just, I was like, there's no goddamn way I'm walking home. Like, it'll take a day is what I thought. And walking upstairs, super uncomfortable. And again, I don't mean uncomfortable like it hurt the muscle. I mean, I don't know what I mean. Just there's some level of uncomfort that was there that drove me nuts. The final really, really interest. Actually, there were two other interesting things. One of them was I talked about how I came into this with a really good meditative routine. But that week it went to another level. So I meditated in a way I've never meditated before. And normally when I'm walking around the street, I always have headphones on and I'm always doing something. I'm either listening to a podcast, listening to an audiobook, listening to music, or talking on the phone. In other words, I am never just walking around, spacing out or taking in the ambient sound. For some reason, on that week, I pretty much always. I'd walk out of my building or walk out of the office or walk out of wherever I was leaving, and I wouldn't even remember to put my headphones in. And I would just walk and I would just look at stuff and, you know, be as present and mindful as any human could be and not even kind of realize it was happening until 20 minutes later when I'd be like, geez, I haven't even, like, made a phone call or checked my phone or done any of these other things. So. So that to me, kind of fit hand in hand with how I felt during the meditation, which was just a. A very unique Sense of calmness that is quite uncommon for me. I think the final sort of subjective, interesting surprise was In December of 2016, I hurt my right wrist moving a bunch of dumb heavy stuff, like totally not a good excuse to hurt yourself. And about a year ago, the summer, last summer, I hurt my left elbow. So I've got this left elbow thing that's kind of nagging me in this right wrist thing that's nagging me. And they're kind of, if I'm, if I'm deadlifting heavy, I need to wrap them in a certain way. And if I, you know, it's just they, they just. I'd been constantly giving attention to these things, sort of constantly getting, you know, Josh working on them and we'd made, we'd made progress. But I mean, I still felt, you know, significant pain, especially in the elbow and at the end of that whole experiment. So it's hard to know how much of it was ketosis, fasting, ketosis. But I would just venture to guess that the fasting play the biggest role even now, how many weeks out we are from this. The right wrist pain is a hundred percent gone. I mean, I can't even remember what it felt like now, which is odd for something that ailed me for so long. And the left elbow pain is almost gone. And it's to the point where I don't have to even put a wrap on it when I'm holding the bow. So one area where I really suffered was holding the bow when I was arching. Arching, Is that even a word? Doing archery. So if I'm holding it out with my left arm, just the pain in the left elbow became kind of my rate limiting, step on shooting and that's completely gone. So I don't know, if nothing else, the whole thing was worth it just for that.

Do you have any speculation as to why sort of the whys behind feeling this calmness and the maybe being more present while fasting?

I was hoping you would. I have no goddamn idea. What do you think?

So, I mean, I did a fast, I did a seven day fast maybe a year ago and I noticed that as well that I'm usually not, let's say present or in the moment. And I felt that I'm not a very religious person, but it felt almost like what a religious experience might feel like. And I know that a lot of religions do fasting. If I were to wildly speculate, part of it I think is you think about alertness, just awareness and alertness and you think it's going to Go in the tank. If I'm not eating, I'm lethargic. I've missed all of my meals the last four or five days. And then I think, well, maybe from an evolutionary perspective that you can get a heightened sense of awareness, because if there's something to be killed or picked out of the ground or something like that, you may need to hop on that opportunity. So you may need to have this heightened sense of awareness. And I don't know if that carries over to cognition. And then I kind of. I thought about, you know, the low and slow exercise that you were doing where it's not very, you know, fight or flight necessarily, even though you're going up like say, a flight of stairs. And it's. It's taxing. Like it feels taxing when it shouldn't feel taxing. It never has in your life, really. But the sort of fight or flight, deadlifting, squatting, doing something that, you know, high intensity, sounds almost counterintuitive. But again, it kind of goes to this heightened sense of awareness or readiness. And it might sound counterintuitive that you've had four or five days of fasting, but it's really like you may. From an evolutionary perspective, you may really need to seize that opportunity. And I don't know if those two things square with this idea of having this awareness. Have it like, you know, I don't know if you guys talked about it. You and Tim Ferriss with psychedelics, for example, when you talk about, like, appreciating things, particularly nature, where you're just more aware of those things. And I don't know if with fasting, if there's some relationship to that, that you're just. You have this heightened sense of awareness and you become more sort of conscious of your surroundings. Don't know if that makes sense.

No, it does. And it's a really interesting idea. And I. I know Tim actually did a fasting, meditative, silent retreat. So he did a Vipassana retreat for seven or 10 days. I think it was seven days. And he also fasted during that period, period of time. So again, I'm curious as to how that experience compared to vipassana retreats he has done where he has not fasted and to experiences where he's fasted and not done the meditative retreat. I also wonder how much of a common element or elements are consistent between the experience I had with sleep and this state that you're describing. Because I again, that that whole sleep thing has really made me question this, you know, addiction. I have to the societal norm of making dinner the social meal. You know, when I, if you look at satchin pandas work and we were all laboratory animals, we really ought to be eating first thing in the morning and then tapering off later in the day if we're really going to follow both our circadian rhythm but also optimize around glucose disposal and insulin sensitivity. So why don't we do that, right? Or why don't I do that? Why do I generally not eat in the morning and then backload it? And it's all social, right? It's like I'm not going to have breakfast with everybody, but I'm going to have dinner with everybody. But of course I have to wonder how much of that experience due to the. Not just the ketones, because I don't, I don't think it was just the ketones because I had this experience even on the first night night when my ketones were probably like one, one and a half millimolar, which is very easy to attain during nutritional ketosis, but it was some combination of the ketones and, or the complete and utter lack of digestive process. And that's made me think maybe I should just be getting up, eating the biggest breakfast in the world and then not eat the rest of the day. Could I pull that off? And I just have been too lazy to try, frankly. But that sleep, like that was awesome. Like I, I want that, I want that every goddamn night because like you could do anything. I feel like there's no end to the type of regeneration you could have with, with what I was experiencing there. So anyway, that's, that's probably my best hypothesis on that. I think the last point, I kind of forgot to make it earlier because we have no allude to it. Again, if you look at the pictures, apologizing for the fact that I'm posting dorky, goofy selfies, I honestly didn't feel like I lost any muscle mass. I obviously lost a little bit. If you're going to lose 12 pounds, my guess is I lost a pound or two of muscle, probably five, six pounds of fat. And the rest of it would have been water mass. Both mass with like glycogen loss in the muscle. So every gram of glycogen you lose, you're losing three or four grams of water that go with it, some reduction in plasma volume as well. So again, we didn't talk much about that. But I, I couldn't believe I didn't lose more muscle mass. Like I, I'm embarrassed to say this, but at the End I was like, I kind of think I look better now than I've ever looked. And you would normally think after a fast you'd be a little kind of decrepit looking. I certainly looked better than I looked, I think going into this experience, which is not to say I look good going into it because I've, I'm sort of not at my, what I would consider ideal leanness or anything. But that was a, that was a pleasant surprise. And again, I wasn't, you know, I wasn't using even, even a gram of branched chain amino acids during that fasted week of working out. So at some point that's going to change. You know, if I did a 10 day fast, a 14 day fast, at some point I expect that would change dramatically. But it was interesting to see that even seven days of not fasting, I don't think it cost me any measurable amount of lean tissue.

Yeah, I think that's fascinating and it's, I think it's a, either a point of contention or it hasn't really been sussed out whether these periods of fast would lead to lean tissue loss over time, which would be particularly if you're thinking of health span and lifespan and over time. If you want to implement, we can probably get into this, you know, when, how often would you implement, say a one week fast or intermittent fasting and things like that. But if you were to do say let's say like a week long fast, twice a year or once a quarter, whatever the, whatever the case may be, if you lost a significant amount of lean mass and over time you're aging. And I don't want to just say that like when you get older there's sarcopenia. But if you're, each time you're going through this fasting period there might be some benefit. But if you were to take a hit on your lean tissue sort of consistently over time, that would be something that you want to sort of jealously preserve is all that lean mass. So that would be one of the potential contraindications of doing frequent fasts. Yet if you can preserve that lean tissue, I think it would be super important to understand and find out. I think a lot of times when you look at the studies, like Cahill studies the subjects, it's a different population, but I also think that they're not engaging in a lot of weight bearing activity. And just from the literature, even on say low calorie diets or high protein low calorie diets, when people do those types of, whether it's calorie restriction or dietary restriction and they engage in a weight bearing exercise program, they're lifting weights, they tend to preserve a lot more lean tissue. That's probably outside of eating protein. Actually. Probably number one is weight training is probably the best way to either add lean mass or preserve it. And then maybe protein intake itself is second.

Yeah, I totally agree with this and I think this is a great example of selective MTOR inhibition. In an ideal world, you don't really want to turn off MTOR in the muscle. I mean, you don't want it on every minute of every day or you'll get muscular dystrophy. But the far bigger issue as we age is MTOR activity going down in the muscle. That's what's leading to sarcopenia. Where I really wanted MTOR to go down for that week was in my liver, in my fat cells, probably in my, you know, myocardial cells and other places like that. But when it came to skeletal muscle, you know, you're exactly right. I think that that's the week you double down on what you're doing in the weight room. If anything, you go out of your way to make sure you send that signal to the muscle. Hey, dude, no shrinking allowed. Now that said, when you did your week, what happened to your muscle mass? Or even if you didn't take the goofy selfies, did you just have a sort of subjective sense of what happened?

Yeah, I mean, I was weight trading I think the entire time.

And because to be, to be clear for the listener, you have a hell of a lot more muscle mass than I do. So if there's going to be a difference, you are going to see it even more amplified.

Yeah, I don't think I lost all that much. Might have lost a little bit. I was definitely engaging in weight training. I had a Tanita bioimpedance scale. And I do remember just in terms of taking out the lean tissue and lean tissue, the fat free mass and the fat mass, it didn't look like, at least on the scale, although that's heavily weighted with your hydration and water status. So I don't know how consistent I was when I was doing it. It didn't seem like I lost all that much lean tissue. And I always think like if I were to do these experiments that I might be different than other people. But the one thing like I don't want to do is just stop exercising. I think it'd be really hard for me to do like a week long fast and not exercise. But it would be I would suspect that you might lose more lean tissue that way. Completely speculative, but I didn't. And there was no similarly. But I don't think that I was doing what you do with those peloton workouts. I think you were talking about cadence. I was going to follow up and ask you if that gives you watts as well, and you can kind of see like what your average power was.

No, no, my wattage was decimated. So I normally ride in power zone. So peloton now allows you to. To see your zones. So there's seven zones. It's like the Andrew Kogan is a bike, you know, physiologist who's created the system, and Matt Wilpers, who's my favorite peloton instructor. He does all of his classes as power zones. So I know exactly what zone 1, 2, 3, 4, 5, 6 and 7 are. And every workout we do is congruent with that. Well, I even going into this said, don't set, reset your expectations. You will do a discount of one zone. So if you're doing a zone, if you're doing a workout, where you're going, you know, two minutes of zone three, two minutes of zone four, one minute of zone five, repeat, I would just do it all minus one. And even doing that, I could not keep up. So in other words, relative to my former self, I was at least 60, if not 80 watts less capable. There was just no denying it. So there is, you know, just a fraction of the ability to put out power on a bicycle. And that might just suggest two different types of demands on the muscle. You know, if you're doing a squat or a row or a deadlift, that's different. That's much harder. It's much. You're asking much more of the sarcomere than if you're riding a bike per contraction. But on the bike, you're asking for many, many, many more of those contractions. And there was just something that I couldn't do on the latter that I seem to have no difficulty doing on the former. I mean, I look forward to revisiting all of this stuff, of course, and, you know, maybe recruiting a few knuckleheads to join.

Yeah. I was also thinking with your wild type diet, you pretty much do one large meal a day, Right. You were alluding to this, that if you did just move, you could try moving that one meal a day to the morning and see how it impacts your sleep and not really change all that much in what you do in a daily routine other than backloading that your food yeah.

Although it would change one other thing, which I wouldn't be able to work out first thing in the morning. So, I mean, I guess. Or what I could do is I could work out first thing in the morning and then say, eat that monster meal right after and then sit there and twiddle my thumbs at dinner and have the same issue I was worried about having with fasting at home, which is, daddy, why aren't you eating? Oh, autophagy. What?

The thing on my license plate.

Nothing on my license plate.

Yeah. Okay.

So I think. Well, I'm guessing there are more questions, actually, because we've. Basically all we've done is kind of go through. I mean, I know you've embedded a bunch of people's questions into those questions. Questions. But are there any other questions?

Yes.

So I. I was afraid you were going to say that.

So I have. Let's see. We have. I segmented them into. So I have fasting modalities, frequencies, duration. So we've talked about a few of these. Intermittent fasting. The fmd. Actually, I want to circle back on that. You. You mentioned that you've done FMDs in the past, and I think you've done. You've done like a. Let's call it the Prolon protocol, where it's relatively. It's low protein, high carbohydrate, and I think you've also done an FMD that's not the. Not the opposite, but you've done a relative, like 700 calories, low carb.

Yeah, I've done, like, ketogenic FMD. Yeah, I've done them across the board.

And do you notice a difference in those protocols?

I notice a difference in my enjoyment level as keto. Counterintuitive as it is, first of all, that it's so easy for me to just eat one meal a day. So whenever I'm fmding, I'm only doing it as one meal a day. Like, the way I look at is I'm gonna blow my load. Like, do it once, right? Like, I'm gonna have my 750 calories in one sitting. I'm not gonna sprinkle it out over the course of the day, which is not how they advise you do it via Prolon. So every time I do it, I do it by just consuming that input at dinner. And that way, it also gets to scratch the social itch, which is I'm going to sit there and have dinner with somebody. Like, at least I can do this thing. So that said, I actually prefer doing a very high carb Low protein, almost no protein, low fat version where I'm getting fat only. Basically my favorite meal when I'm prolonging or I mean I'm just using that term, but you know, what I mean is, is salad and rice. 750 calories of salad and rice is like from a volumetric standpoint actually pleasing enough that I feel like I'm eating. The problem with doing the 750 calorie a day keto diet, which probably in the end is more satiating, is just volumetrically. It's trivial, right? Especially with the stuff I like to eat. Macadamia nuts, avocado. I mean you're, you're, you know, you're olive oil, you're kind of done, you know, you're, you're sort of, there's the, you don't get to eat a whole heck of a lot. So. But again, I want to take a step back from all of this. I'm not even suggesting that I have a clue what the optimal fasting regimen is. Whether you should be doing a five day FMD quarterly, whether you should be doing a seven day fast, quarterly, whether you should be doing a five day fast, water only quarterly, whether you should be doing a day, a week, you know, with nothing in it. I mean, that's the whole point here. Nobody knows the answer to this question because it would be impossible to study this in humans using the metrics that are necessary to actually extrapolate to the things that matter most. With the technology we have today, we just don't have the tools developed to do this. So obviously the FMD has been probably studied. The five day FMD has been studied more than any of these other routines because it's at least been studied in Longo's lab. But you know, we're comparing it to what? We're comparing it to someone eating a standard American diet. Well, a lot of things are better than a standard American diet, so. And I think Valter is honest in his assessment of that, which is, look, he's not, I don't think he's claiming this is the optimal way. He's claiming this is an effective way. In other words, it's not the most efficacious. It's not the quote unquote dietary regimen that will produce the best result. It is one that is very easy to follow. For that reason, I think it's, you know, it's a great tool. We use it constantly with our patients. But I'm looking for something different, right? I'm looking for the best, not the easiest.

And so you may have answered the question by saying there is no answer, but there are a lot of questions about the optimal number of fasts per year and in terms of what is the optimal frequency and duration and things like that. Obviously we don't have a concrete answer on that stuff. But is there something that you, you think is likely to provide benefit as far as if you're going to do a one week fast once a year? Man, depends on the person.

I wish, I wish, I wish I knew. I would say the following, and this is 100% speculation. So it's, it's just, it's, you've got to be able to sort of take it with that. I'm convinced that an important tenet of longevity is exposure to nutrient cycling. What that does is autophagy up and down, anabolism, catabolism, MTOR up, mtor down. I think if you want to live long, those things have to be happening. So I don't think that doing a seven day fast once a year and for the other 51 weeks of the year just eating like shit is going to do that much. It's probably better than just eating like shit 52 weeks a year. But I don't know if it's enough to move the needle. I mean, I don't know. Again, I have a sense of what we would have to be able to measure to at least directionally answer that question. But we don't know because I don't think the answer to that question can be addressed through standard blood draws or, you know, scans or things like that. I mean, these are cellular questions. So there's probably a little bit of the frequency of the fast might be a function of the damage you do off the fast, if that makes sense.

I think it does.

The worse you want to behave when you are not fasting, it might be that you need to fast more frequently, the better you want to behave. So, so if someone said to me, hey, if Dom said, hey Peter, I'm going to go on a ketogenic diet, you know, completely strict, super clean, whatever, and it doesn't have to be keto, I'm just using that because Dom's on a ketogenic diet a lot of time and once a year I'm going to do a seven or 10 day fast, is it adding value? My guess is yeah, it's probably adding value because he doesn't have that much damage to undo and he's using that week just mainly as a way to really shut down Tor but if, you know, someone says to me, look, man, I'm a burger and fry guy, what, But I'm willing to not eat at certain points in time, what should I do then? The answer is I, you know, maybe do time restricted feeding as a way to minimize the damage of the burger and fry, and then maybe do these fasts more frequently. And then, then, but, but again, you can see I'm, I'm. It's just, I don't know.

Yeah, I think it makes intuitive sense too, that Longo pointed this out. I'll probably, I'll probably butcher the, the idea or the protocol, but I'll hopefully get the gist, which is not just how bad is. I think he advocates for essentially more or less it rhymes with a reasonable diet where you're cutting out refined grains, carbohydrates, sugars, et cetera. But really, what state are you in? I think he asked that question as well. Are you diabetic? Are you hyperinsulinemic, do you have metabolic syndrome? All these different things. And if, if you're in a relatively poor state, I think he advocates for doing more FMDs, you know, doing them more frequently, and as you get to a better state, a leaner state, then maybe you can get away with doing fewer FMDs. In terms of optimizing your health. Sounds sort of similar to that.

Yeah. Again, I can't tell you how much I want to help generate or be a part of generating some of these tools. So we can actually start to look at trade off and start to figure out like, what's the, what's the gain? You know, how much, how much incremental benefit do you get by increasing the frequency of the fast? I mean, I don't even know when I'm going to do the next one of these. I mean, I sort of directionally came up with a protocol that said, look, this should be done every quarter. You do the KFK sandwich per quarter, and then that gives you, you know, 13 weeks to a quarter. So you do that for three weeks and then you've got 10 weeks of going back to relatively clean time, restricted feeding. Okay, cool. That's probably better than, you know, eating normally, but. All right. Is it overkill? Is it, is it enough? Drives me nuts not to know that, but I'm really not interested in talking about it that much more because I don't think I'm going to learn anything more just by sort of imagining what it could or couldn't be. I think, I think we just, we just have to go after some of these cellular assays that can measure metabolic, as I said, proteomic and other molecular markers or signatures of what we believe is happening in these states.

Right. So this one I think is relevant and maybe you can help answer this one. This is something I experienced as well, and there were several questions about this. So if you do a seven day fast or a ten day fast, I think I'm stealing this from Dave Asprey where he, he calls it disaster pants. I think he's talking in terms of like MCT oil taking too much. But after my fast at least my mentality was I had like set a date on the calendar. I had a, like a went to a steakhouse and was just, you know, ready to eat my face off. And I probably did. And it more or less went through me. And it sounds like a lot of people out there saying the same thing, that they get a lot of GI distress when they're reintroducing food after a fast. And they were wondering if you have like your best practices, what works for you or what are the things to avoid in terms of breaking your fast.

So I don't have, I didn't have any GI distress, breaking the fast, and I only actually I didn't get into this. But if anything, I mean, what. The other thing that I didn't, I just forgot to mention was the entire time I was fasting after the first day, there was no normal bowel movement and it was pure liquid and it was basically bile. So it was just bile coming out of me as liquid. And so that's just a different sensation. So it's all of a sudden it's like there were times when I'm walking down the street where I was like, I probably need to find a bathroom at some point. Like, I felt like there was this collection of bile waiting to exit my body. The biggest issue I've had, and I've had this so many times, and you'd think I'd learned my lesson. And even though intellectually I know this, I still screw it up like a moron. It's the volume when you've been fasting. I am convinced because we used to see this in patients with nasogastric tubes in, in the hospital, the stomach is so decompressed for so long that if you overfeed and just put so much volume back in the stomach, you get the hiccups. And again, I used to see this in the hospital all the time. You had a patient had a nasogastric tube in for a week, you take it out and they start eating or drinking again. And all of a sudden, even if they're just drinking a bunch of water, they, they just get the hiccups. And so sure enough, that first night when I ate and I had, I made the Atia curry stir fry, which is certainly among my three favorite meals. Not a particularly caloric meal, right? It's mostly vegetables and stuff like that, but I just, I ate and ate and ate and ate, and I got the hiccups. Like I've never had it in my life. So much so that I actually had to take like a pretty interesting drug, a Neurontin, which I had some of it lying around just to try to like chill out my diaphragm a little bit. And I probably had the hiccups for like three hours, which is if anybody's had the hiccups for more than 10 minutes, I think they'll attest to the discomfort of that. That said, from a GI standpoint, I didn't have any issues. You know, once I got some fiber back in my diet, I was sort of right back to feeling completely normal in that regard. But yeah, I'll definitely, I say I'll do it. I might not. But I'd like to think that the next time I fast, I will be much more thoughtful about my re entry volume strategy.

When you, your first meal and after the fast, as I recall, you didn't necessarily go to town with whatever the meal was, right?

Oh, that's a good point. You're right. You're right. My very first meal, I had a little snack before I had the stir fry. And you're right, I was actually pretty, pretty timid. I had a small salad and a small cup of chili, which was odd, but that was sort of like what was laying around. And that felt totally fine. But then a few hours later, when I went for the big kahona, that's when the hiccups ravaged me.

Okay, I've got the what abouts as I like to call them, which is am I breaking the fast? If, if I'm taking mcts, if I'm taking exogenous ketones, if I'm drinking coffee, if I'm drinking tea, if I'm adding artificial sweeteners to those things.

I mean, all great questions and of course, we simply don't know the answer to these questions. It is a function presumably of what you are fasting for. So if someone says, I'm fasting because I want to have no calories, because I want to lose weight, which there's no more direct way to lose weight than to not eat anything, then it probably doesn't matter if you're consuming non caloric entities, regardless of their impact on you. So, you know, in theory, I don't think having a diet Coke or a coffee, a black coffee with nothing in it, is from a caloric standpoint, impacting energy balance. Now I think the problem with having a Diet Coke during a fast is it's going to F up your s. I'm glad you got that. Like I love when I'm just talking.

Yeah, I've got like a quarterback wristband where I have, I have all the abbreviations. It's like.

That's effing up his ass, man. Okay, let me check that out. Okay, got it. You know, but I think it's just, it just, it just resensitizes your appetite, you know, certain appetite centers centrally to like, oh my God, should I be eating more? And again, whether there's a cephalic insulin spike or not, that would be measurable. And my guess is that would be variable. There's some people that might experience it, some people might not. But I just think sort of there is something to be said for just kind of keeping it clean in that regard. Now I think with coffee the bigger issue is that caffeine can truly affect lipolysis and it might sort of artificially create a slight environment of a fed state. So that was the reason that I just decided to say no on that. But obviously I didn't say no to, you know, non caffeinated tea. But you know, the way I would say it is like, use your common sense. First things first, if you're fasting, know why you're fasting. If you think you're fasting because of something to do with nutrient sensing, autophagy and things like that, then you're probably best off having as much nothing as possible. But at the same time, like, you know, let's major on the majority and minor in the minor. And I think whether you're having a green tea versus a Rooibos tea versus, you know, a coffee is probably a fourth order consideration. If you're doing a three, five seven day fast, you know, it probably isn't nearly as important as say the fasting, right?

And depending on the protocol, there is not a ton of data, but there is some data. For example, the. What's the alternate day feeding where every other day you're fasting. Although technically when you read these papers, your fasting day is, I think it's up to 500 calories. Is still considered a fasting day or the 5, 2 diet. So there's two days of fasting, right? You know, theoretically, but again, but they're.

Not back to back right in that.

I don't, I think there's some flexibility, but I don't know if there's like a standard protocol. Typically it's probably that there's, you're wedging it in your week. But again, on those, those two days, I think it's five, 500 calories or less. And then Longo's fasting mimicking diet, I think day one is something like a thousand calories and then days two through five are 700 calories. And based off of his experience, I think he looks at IGF1 a lot and some other marker and IGF BP, I want to say three is what he looks at. He looks at those two things and part of why he says it's a fasting mimicking diet is because he sees some of these markers move in a similar direction to where you're fasting. So coffee tea. That might be majoring in the minor in some of these instances, but I think I just wish we had more information on all this stuff.

Yeah, me too, for sure.

So I think we covered a lot of questions within. Just going over your experience and some of those follow up questions. I'm trying to think if there's anything else. I mean, although the labs are somewhat boring, it would be great to do a deeper dive into the labs and things like, you know, why are some of the numbers doing what they're doing? I think you mentioned it that you weren't flagging things with reference ranges. It's that you know, you know what your numbers are and you also. So if there's something that you flagged as like that's interesting or that's strange, you flag those things. And I think I'm gonna. Again, I'm trying not to open too many windows on my computers because I don't know if it's superstitious with Skype, but I think it was Isaac Asimov who said something like, you know, the great discoveries in science are not Eureka. They're. That's funny. You know, so even though it's an N equals 1 and it's very little data, I do. It's, it's always very interesting. It's interesting when you find something that's a little askew and maybe it's just a, you know, an artifact or a rounding error, but some interesting stuff.

The thing that fits that description the most for me is actually the uric acid of 8 after the fast. So even though the thyroid numbers are comical and the testosterone story is interesting, I can, I think I can generate reasonable hypotheses around them, especially the thyroid stuff. But given my interest, particularly in understanding any and all inputs to an autophagy model or predictor, it's the uric acid I'm really going to want to watch in other people that do this and in myself when I do it subsequently, because if that is in any way a proxy for cell breakdown and nucleotide breakdown, so DNA and RNA destruction, that could be a little piece of this question, which is, are we actually undergoing autophagy at a meaningful enough level? So, yeah, there are a million labs on this page. There's a million numbers here. There's a. There's an infinite amount of data one could extract from all of this. That's my interesting moment.

Yeah.

Which by the way, might turn out to be entirely irrelevant. It probably will, but can't wait to get on it.

Yeah, it's funny, it's like a double whammy. You've got almost like an infinite number of variables that you can speculate about, and yet you're also limited in the equipment that you can use to actually look at many of the things that you want to look at in terms of things that would push the needle.

Yep. So anything else question wise from folks that we haven't sort of implicitly or even explicitly covered?

I think we covered most of it. I mean, we have a bunch. I have a bunch of questions at the bottom, but I think we covered just about all of it. I think, like many things, you'll put this out and then there'll be a lot of follow up, a lot of follow up questions and things like that. But I think you covered a lot of ground.

All right, well, sweet. So this, this will be our. So we are sitting here recording this on August 14th. I'm hoping we can get this out next week right after the Matt Kaeberlin podcast. Is that, do we think that's feasible?

I think so. I think that'd be excellent. We can turn it around. That'd be great.

Sweet. Alrighty. Well, Bob, thank you very much for cataloging and organizing all this info.

You're very welcome.

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