#62

We may not have enough info to know, but from what we do know I don’t think that would be the conclusion

Peter still talks a lot of about optimizing glucose control as part of his metabolic health pillar which is one thing things he feels people can influence the most - see his book, see different podcasts this year.

At least as late as December, 2023 he focus in on glucose regulating medicines acarbose and especially Cana/SGLTi as a key longevity modecules (#281 ‒ Longevity drugs, aging biomarkers, and updated findings from the Interventions Testing Program (ITP) | Rich Miller, M.D., Ph.D. - Peter Attia)

The data that seems to have changed his mind about Metformin was about mitochondria/lactate and excessive. He kept experimenting with acarbose after he stopped that and even more recently I believe reported to take Cana.

The original podcast does not seems to have any information or papers that I’ve seen Peter Changing his mind on (not related to the metformin concerns he has for a heavy exerciser).

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#63

@Thiago My fasted HIIT was not a plan. I usually skip lunch, and there was a time when I was doing 1-hour spin classes after work that were very hard core. Just murder. I would lift weights afterwards. Sometimes it was too much.

I do think that fasted cardio was once thought to build mitochondria and increase glycogen storage capacity. I don’t know if that is believed any longer but I was at my max VO2 in those days.

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#64

I do fasted workouts too, including sprints. Tomorrow I’m doing a sprint ladder on the local high school track:
100m, 200m, 400m, 800m, 400m, 200m 100m. Recovery between these is variable. I just walk until my Moxy (Muscle oxygen sensor) tells me the oxygen in the quads is back to the warm up level.

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#65

I think one of the possible mechanisms of action for Acarbose is that the partially digested carbs promote a healthier gut microbiota:

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#66

Could be. I actually drink lactose free milk most of the time because regular makes me a little gassy.
As an aside, I am having unexpectedly good results from Jardiance. I am taking Jardiance alone because because like regular milk, metformin no longer agrees with me. The Jardiance alone has brought my fasting glucose levels to 85 - 95 mg/dL.
I eat a low carb diet. It took about a month for Jardiance to bring my levels below 95.
I also take Acarbose before any meal that is not low carb.

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#67

I understand, but why would you do that?
Fasted workouts and a low heart rate I understand.
We know that if you want to improve speed performance or have a quality workout, you should have carbs in your system. If you search on PubMed, you can see several comparisons of low vs. high carbs.
If you are doing intense exercise in a fasted state for metabolic health, I believe it’s also questionable. Some studies even show an increase in inflammatory markers, hormonal imbalance…

I am not against fast. Actually when I do water only fasted for days I also run or cycle every day on comfortable pace (which also might not be the best strategy).

I am not against anyone, just want to understand your thought process.

Thank you guys.

#68

Thank you for that. I have a very similar thought process as you. We probably work in a very similar way with our clients.

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#69

My primary goal with HiT training is to produce lactic acid. This is because of the positive effect lactic acid have on the brain. Another goal with my HiT efforts is to keep as much as possible of my fast oxidative (type IIA) fibers in my leg as functional as possble. A third goal is the general effects that HiT traininghave on my cardiovascular system. If HiT could send my ketone levels very high? That would be another health benefit that I would apreciate a lot. Thank you for bring up this possibility.

#70

Thank you for the answer.
I do understand your point now. Maybe you should think about the possibility of being with your muscle glycogen full before doing a HIIT. You will reach, in theory, much higher numbers (wattage, speed, or weights),which will probably also allow you to achieve higher lactate levels to pass through your brain.:grin:

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#71

By fasted I mean I run in the morning and I don’t eat before. I’m not talking about a multi-day fast which would be totally different.

In my case even though I’m eating low carbs, I do have plenty of glucose in my blood. Too much in fact.
All the zone 2 running has made me super efficient at fat burning and when I run in zone 2 I don’t use much if any glucose and my glucose blood level stays stable.

When I run faster than zone 2 and I start to also burn glucose, my liver makes plenty of it. Too much actually and I see the glucose plunging then rising up above the already elevated starting point.

BTW according to my Stryd, my running power was above 400W for 36s for my 200m sprints.
That’s 14000 J = 3.3 kcal. Carbs are at 4kcal/g so that’s 0.825g of carbs if I only used carbs during that run.

The total session used 403 kcal according to my Garmin watch but most of it is the zone 2 warm up, recovery and cool down which are not really using carbs.
My ketones did not rise either.

Really no need to eat carbs before an HIIT session.

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#72

Can I ask are you using 10mg or 25mg Jardiance?

#73

I am using 10 mg. I would try it for at least 30 days before switching to 25 mg if 10mg doesn’t give the result you want.

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#74

@desertshores What results are you looking for with Jardiance? (I take 12.5 mg)

#75

As an aside, I am having unexpectedly good results from Jardiance. I am taking Jardiance alone because because like regular milk, metformin no longer agrees with me. The Jardiance alone has brought my fasting glucose levels to 85 - 95 mg/dL.
I eat a low carb diet. It took about a month for Jardiance to bring my levels below 95.
I also take Acarbose before any meal that is not low carb.

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#76

This is relevant around why lowering glucose levels and peaks can be helpful for longevity:

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#77

The size of spike probably matters. I see no evidence that eliminating transient post-prandial increases (say around 140 mg/dL or a bit higher) which go back baseline in 2 hours are harmful especially with a blood profile you noted earlier and the youngish age. Probably better to spend time and effort elsewhere. Also, I haven’t looked at the ITP study, but my guess is that it was not carried out on mice in ideal health. Plus, dosage conversion from mice to humans is an ongoing issue.

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#78

I agree about Attia and diet. I prefer experts like Walter Willet and Gary Fraser who have studied diets academically for decades and can show a lot of what I consider to be solid evidence supporting a plant-centric diet. Would prefer if more people, including Attia, would just not say anything, or admit their lack of depth knowledge, rather than trying to pass off an opinion as fact. He should know better considering the apparent pains he goes to analyze things. I will only listen to his podcast when he has a real expert on.

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#79

Do you think about harmful as the same as being not optimal?

Do you see any evidence in the other direction, ie that going up to around 140 vs say just 130 is optimal?

For instance, do you not see this as relevant:

#80

What would be interesting is to see what the normal glucose pattern is for a teenager or someone in their 20s.

As far as I can see keeping below 140ish is a good idea, but one should not particularly worry about post prandial peaks that go up to 140. My CGM charts from early 2022 were much worse than they are now and I often had glucose meandering around the 10mmol/L mark.

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#81

@John_Hemming What are your thoughts on glycation as one key parts of aging?

Seems to me that that is (slowly) accumulating problem that we’d want to address?