#103 - Looking back on the first 99 episodes: Strong Convictions, Loosely Held
In this 100th episode, Peter Attia, MD, discusses how his "strong convictions loosely held" have evolved on various topics since starting The Drive podcast, including Metformin, Rapamycin, exercise, and generic drugs, often changing his behavior for the better.
Deep Dive Analysis
13 Topic Outline
Introduction to 'Strong Convictions Loosely Held' Philosophy
Peter's Evolving Views on Metformin Use
The Decision to Get a Dog and Its Impact
Rapamycin: Current Understanding and Unanswered Questions
Archery as a Pursuit of Mastery and Process
The Importance and Benefits of Zone 2 Training
Deadlifts: Re-evaluating Their Role in Longevity
Book Recommendations and Reading Habits
Rethinking Baby Aspirin for Flight Thrombosis Prevention
Shifting Perspective on Generic Drug Efficacy
Evolving Understanding of Omega-3 Fatty Acids (EPA/DHA)
The Art of Saying 'No' and Guarding Time
Reflections on Favorite Episodes and Podcast Journey
5 Key Concepts
Strong Convictions Loosely Held
This philosophy involves forming strong beliefs or hypotheses but actively seeking out information and data that might challenge or disprove them. It is viewed as crucial in science and medicine for continuous learning and adapting one's perspective.
Blank Bailing
A practice in archery where one shoots at a large target without a specific bullseye to focus purely on the shooting sequence and muscle memory. This helps archers improve their process-oriented skill rather than fixating on the outcome.
Stillness
A state of being that is not object-oriented or outcome-based, providing a forced reason to be present without an agenda. It contrasts with activities driven by competition or specific goals, offering intangible benefits.
Zone 2 Training
Low-intensity aerobic exercise where the heart rate is elevated but lactate levels remain low. This type of training is beneficial for metabolic health, mitochondrial function, and the secretion of neurotropic factors like BDNF.
Dynamic Neuromuscular Stabilization (DNS)
A rehabilitation and exercise approach that focuses on restoring ideal movement patterns and core stability. It helps ensure proper biomechanics, even in complex movements like deadlifts, by emphasizing correct posture and muscle activation.
11 Questions Answered
It means having firm beliefs or hypotheses but actively seeking out information and data that might challenge or disprove them, especially in scientific and medical fields, to foster continuous learning and adaptation.
Peter previously took metformin for longevity benefits but stopped after realizing it's a weak mitochondrial toxin that elevated his lactate levels. He now reserves it for metabolically ill patients, questioning its net benefit for metabolically healthy individuals.
Despite initial reluctance due to perceived workload, Peter caved after his family found a visually impaired rescue puppy named Molly. He now appreciates the intangible benefits and forced stillness a dog brings, despite the unexpected work.
Peter's interest in rapamycin grew significantly after a 2014 study showed its analog augmented vaccination strength. He now uses it, cycling the dosage, and has high convictions about its potential benefits, though he still seeks better biomarkers for efficacy.
Archery is a pursuit of mastery with no ceiling for improvement, serving as a metaphor for life by focusing on process over outcome. It involves practices like 'blank bailing' to build muscle memory and improve technique.
After neglecting low-intensity aerobic training, Peter recognized its benefits for metabolic health, mitochondrial function, and neurotropic factors like BDNF. He now dedicates several hours a week to it, combining it with learning.
After an oblique injury, Peter initially avoided deadlifts but re-embraced them through Dynamic Neuromuscular Stabilization (DNS). He now uses them as an 'audit' for perfect biomechanics, focusing on light weights and perfect form to translate to daily living activities and even create spinal traction.
Peter stopped taking baby aspirin after finding little evidence of its efficacy for preventing deep vein thromboses (DVT) on airplanes. He discovered other agents like Flight Tab and natokinase had more evidence for DVT prevention.
Initially believing generics were identical to branded drugs at a lower cost, Peter's view shifted after observing cases where generics seemed ineffective (e.g., statins) and a podcast with Catherine Eban. His practice now prioritizes branded drugs or carefully vetted generic manufacturers.
Peter now views EPA and DHA as potent drugs, with pharmaceutical-grade EPA (like Visepa) being as effective as any anti-cardiovascular disease drug. He aims for higher RBC membrane levels (12-14%) than previously (8-10%) but still questions the role of omega-6 PUFAs.
Peter used to say yes to everything but has significantly improved, realizing that saying yes to one thing means saying no to another. He now practices asking for time before responding to requests, allowing for more considered decisions.
17 Actionable Insights
1. Actively Disprove Hypotheses
In science and learning, make a hypothesis and then actively try to disprove it, as rigorously challenging your own ideas can lead to clearer understanding and simplification.
2. Master Saying No
Improve your ability to say no by recognizing that every “yes” is a “no” to something else, and practice asking for time to consider requests before committing.
3. Cultivate Non-Objective Stillness
Integrate activities that are not outcome-based into your life, such as walking a pet or swimming without tracking performance, to achieve a crucial form of stillness and mental calm.
4. Prioritize Zone 2 Training
Re-incorporate low-intensity aerobic (Zone 2) training into your routine for metabolic benefits, mitochondrial health, and neurotropic factors, and consider combining it with learning activities.
5. Perfect Deadlift for Biomechanics
Re-engage with deadlifts, focusing on perfect form with lighter weights and slow eccentrics, to audit and improve biomechanics, create spinal traction, and translate to better daily movement.
6. Re-evaluate Metformin Use
Reconsider metformin’s use for longevity in metabolically healthy individuals, as it acts as a weak mitochondrial toxin and can elevate lactate levels, potentially limiting its benefit to those with metabolic illness.
7. Consider Rapamycin for Longevity
Explore rapamycin as a potential longevity agent, noting that while dosing and cycling protocols are still being refined, current convictions suggest it offers benefits, despite lacking immediate biomarkers for efficacy.
8. Optimize EPA/DHA Intake
Recognize EPA and DHA as potent agents, particularly EPA for cardiovascular health, and aim for higher red blood cell membrane levels (e.g., 12-14%) to maximize benefits.
9. Exercise Caution with Generics
Be cautious about generic drugs, especially for those with clear biomarkers, and consider working with pharmacies that prioritize branded drugs or cross-reference generic manufacturers with FDA lists of potential bad actors.
10. Re-evaluate DVT Prevention
Reconsider the efficacy of baby aspirin for deep vein thrombosis prevention during flights, and instead explore alternatives like natokinase or Flight Tab, which have more supporting evidence.
11. Pursue Mastery Consistently
Dedicate time daily to pursue mastery in a chosen domain, focusing on the process (e.g., blank bailing in archery) rather than just the outcome, as continuous improvement and the craving for getting better are deeply satisfying.
12. Transfer Mastery Skills
Understand that the discipline and effort required to achieve mastery in one area, such as a sport, can develop transferable skills like grit and work ethic that benefit intellectual pursuits and other life domains.
13. Embrace Unforeseen Joys
Be open to experiences like getting a pet, even if they seem like more work, as they can provide intangible benefits and a unique form of “stillness” not appreciated through logical reasoning alone.
14. Reread Impactful Books
Reread books that deeply resonate with you, like “Stillness is the Key,” multiple times to fully absorb their wisdom and consider gifting them to others.
15. Value Deep Preparation
Recognize that significant learning and changes in perspective often occur during the preparation phase for discussions or tasks, not just during the public discourse itself.
16. Overcome Initial Resistance
Overcome initial resistance to new endeavors, like starting a podcast, by recognizing that perceived workload might be manageable with a supportive team, leading to unexpected enjoyment and growth.
17. Learn from Peers
Actively listen to and learn from other high-quality podcasts or peers in your field to gain insights and improve your own craft.
6 Key Quotes
What you do in science is you make a hypothesis, and then you try to shoot yourself down.
Richard Feynman (quoted by Bob Kaplan)
I think that when I've written this before, I think in politics, that may be a cop-out, but I don't think in science or in medicine that should be viewed as a cop-out. I think one should always be malleable and willing to sort of lean into new information.
Peter Attia
I do pity the person who's never found it interesting to try to get better at something.
Peter Attia
Not everything in your life can be outcome-based.
Peter Attia
When you're saying yes to something, you're actually saying no to something else. You just don't know what that something else is yet.
Jason Freed (quoted by Peter Attia)
My thing is I usually go in the sauna about an hour a day and I either print out a stack of papers that I want to read for research or just read a book in there.
Bob Kaplan
1 Protocols
Peter Attia's Deadlift Preparation and Execution Protocol
Peter Attia- Perform 10 preparatory exercises for 10-15 minutes to warm up and activate necessary muscles.
- Deadlift with either a straight bar or trap bar at least twice, often three times a week.
- Focus on perfect form using lighter weights (e.g., 185 lbs for straight bar, 350-375 lbs for trap bar maximum, but often lighter).
- Incorporate slow eccentric movements during the lift.
- Film every single rep of every set for self-analysis and feedback.
- Study the filmed reps and send them to a coach (Beth Lewis) for detailed review.
- Ensure correct biomechanical elements: optimal thoracic extension, proper lumbar spine curvature, activation of glutes and hamstrings, pulling back instead of just pulling up, and correct wedging.
- Actively create traction in the spine during the deadlift by understanding proper positioning and intra-abdominal pressure.
- Perform this routine before flying to prime the body to maintain activated spinal traction, counteracting spinal compression during long flights.