Video summary
Dr. Peter Attia addresses supplementation strategies for enhancing focus, beginning with his personal experience regarding caffeine and nicotine. Although he consumes 300 to 400 milligrams of caffeine daily due to its taste and ritualistic value rather than perceived cognitive benefits as a fast metabolizer, he finds more utility in nicotine patches or gum for inducing heightened awareness. Attia explains that nicotine is an unusual molecule with biphasic effects; low doses concentrate the mind while higher doses become sedating. He notes that standard 7-milligram pouches often cross this threshold too quickly to be effective for focus and can induce nausea if taken in excess, whereas chewing gum allows for precise dosing of two milligrams at a time to achieve the desired state without overstimulation or relaxation. When traveling across multiple time zones, Attia relies on Mael (likely referring to Modafinil) as a tool for resetting circadian rhythms rather than relying on it daily. His strategy involves inducing sleep immediately upon entering a new timezone by utilizing a specific protocol that includes phosphatidylserine and trazodone. Phosphatidylserine inhibits cortisol output from the adrenal glands, while trazodone, originally an antidepressant with sedative side effects now repurposed for insomnia, helps induce appropriate stages of sleep rather than just drowsiness. This combination allows him to shut off his "adrenal" response and fall asleep quickly despite being awake internally according to his home time zone. The discussion then shifts to the complexities of melatonin dosage, where Attia argues that over-the-counter supplements often provide doses far exceeding physiological needs. The human pineal gland naturally produces only micrograms of melatonin, yet standard pills contain 1 to 5 milligrams (1,000 to 5,000 micrograms), and some reach up to 10 milligrams. Attia cites literature suggesting that doses north of 6 or 7 hundred micrograms tend to suppress brain receptors over time, making high-dose reliance a poor long-term strategy. Consequently, he reserves melatonin strictly for jet lag situations lasting less than 48 hours and advises patients against using it as a nightly sleep aid unless absolutely necessary during travel. Regarding the effects of Mael upon waking in London after his flight protocol, Attia typically takes 200 milligrams if needed, noting that while he feels fantastic and more awake without experiencing a "high," some individuals may experience negative stimulation similar to old amphetamines if they take too much or are highly sensitive. He emphasizes that these adverse effects often stem from overdosing rather than the drug itself being inherently problematic for everyone; his wife, who cannot tolerate 200 milligrams, might function well on a lower dose of 50 or 100 milligrams under specific circumstances. Ultimately, Attia advocates for using such compounds judiciously to manage acute travel demands while avoiding physiological dependence and receptor suppression through excessive dosing.
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what about supplementation or
pharmacologically what are you using if
you need to dial in focus a little bit
more nothing um I well I shouldn't say
nothing so I love caffeine although I
I'm not convinced I'm really getting a
benefit from her from it I am a very
very fast metabolizer of caffeine so I
probably consume 300 to 400 milligrams a
day but if I don't nothing happens like
I I can't appreciably tell a differ so
for me it's I love the taste I love the
ritual I love making coffee my wife
loves coffee it's the one thing I can do
first thing in the morning that makes
her happy uh you know so it's like you
know you know it's it's so I don't I I
don't even though people would argue
that caffeine of course is a cognitive
uh booster um I'm not convinced I
appreciate the the the metrics of that
um I do occasionally uh put a nicotine
patch in my mouth I probably get more
benefit from that um truthfully and
maybe I'm just not aware of other
products the product I use I think is
too high a dose so you have to it's a 7
milligram pouch so you have to kind of
time it because as you probably know
nicotine is a very unusual molecule
where at low doses it provides a
heightened sense of awareness so it's
actually concentrating you but then you
actually cross over a hump and then
nicotine becomes actually quite relaxing
and sedating I didn't know that yeah
it's it's an unusual molecule in and it
has Behavior so um both of those
properties are ideal it's great to be
focused when you need to be focused it's
also great to be relaxed when you need
to be relaxed it's just you don't want
those at the same time
withes people that I'm be you idot know
all this sets are there um I used to I
used to enjoy gum more because you could
chew two milligrams at a time which was
really the right dose to just induce the
focus um again nicotine is an addictive
compound so I say I don't say this
lightly um but for whatever reason I
don't appreciate any of that so in other
words I might have it three times a week
for a month and then forget about it for
6 months and I don't seem to miss it in
any way shape or form um and obviously
the mode of delivery matters so you know
I'm not remotely interested in yeah I'm
not I'm not at all interested in in in
that um it's it's got to be basically
gum or a lozenge or something it's so
interesting that the dose can take you
from where you want to be to where you
really don't want to be but it's the
same yeah or it depends like again
sometimes if if you know and I don't use
it in this capacity but if you really
need to relax SE 7 milligram slug of
nicotine will relax you make want to
throw up that would make me want to
throw up everywhere I'm very nicotine
sensitive yeah no that's a real issue so
what about we're talking about there's
one other compound that I add to the
list although I rarely need it but if
I'm doing a lot of time zone movement I
will also lean on
mafel okay and how would you use that
for yourself just use it as a quick
reset on circadian rhythm in the new
time zone right so for examp take first
thing in the morning yes so take it
first thing of the morning of the new
time zone which is not the new which is
not my morning internally right so if I
had to go to London tomorrow um and I
had to be there for 48 hours and then
come right back my strategy is let's say
I'm leaving Austin at 2 p.m. so 2 p.m.
Austin time is what's that 900 p.m. 8:
p.m. depending on daylight savings so I
would go put myself to sleep on the
plane within 2 hours so that I go to bed
London time even though it's 400 p.m.
Austin time and I don't want to go to
sleep and then what would you do to
induce sleep given kind of a whole long
protocol but basically it comes down to
how early did I wake up in Austin the
day of when did I exercise what did I
eat and then I'm going to try to shut
off my adrenal glands with phosphole
Serene um I'm going to take Trazodone a
dose of a high dose of Melatonin which
is not something I normally use to sleep
and that's going to put me out what were
the first two things that you mentioned
uh phosphole Serene and trazodone do
they do
phosphaline uh inhibits cortisol output
from the adrenal glands and trazodone is
a funny drug it's um it's actually it
used to be used as an anti-depressant in
the 80s but it never really took off
because it had this um nasty side effect
of making you tired so as ssris and the
like came on board it sort of fell by
the wayside we now use it as a
remarkable sleep drug it's incredibly
safe and more importantly it doesn't
just induce sleep it induces stage
appropriate sleep it's a very helpful
drug for people who um don't suffer from
any initiation insomnia but who do tend
to wake up intermittently at night
either due to anxiety or you know just
any anything that kind of gets people up
trazodone basically buzzes over SM that
out yeah okay so you've then taken that
melatonin what sort of dose again
normally I don't take any but if I'm
looking for the hammer I'm going to take
three milligrams wow yeah that is a lot
I mean here's just before we go on to
how to them wake up when you get to
London the levels of dosage that you can
buy in CVS of melatonin crazy is wild
can can you just give the overview of
how the dose curve works for melatonin
with humans well I mean what's
interesting is physiologically the
pineal gland doesn't make that much
Melatonin right it's making um
micrograms of the drug so I think the
smallest dose I've ever seen that you
can buy might be 300 micrograms like
maybe there's someone out there that
makes a of a Mig y yeah that's probably
the smallest I've seen maybe there's a a
0.1 out there I've got a uh a spray and
each spray sublingual spray of it is.
three okay yeah so unless I can like
manage to half trigger it there's no way
I could get but most of the time you're
looking at one to 5 millgram
I.E 1,000 to 5,000 micrograms of this
stuff and even 10 milligrams and the
problem with that is it seems if if you
look at the literature uh and I haven't
looked in a while but the last time I
did doses north of about 6 or 700
micrograms 6 to7 milligrams tend to
really suppress melatonin receptors in
the brain and so as a long-term strategy
it's probably a bad idea so would that
create basically a physiological depend
y so my I try to get patients off
melatonin truthfully and reserve it for
jet leg and for travel only and and not
rely on melatonin as a as a nightly
sleep aid but for a but if you're going
to I I want them to be as low as 48
hours I can't mess about here I need to
hit it with a hammer yeah if using this
example if I I want to fall asleep at
what feels like 4:00 and wake up in 7
hours and then two hours later land in
London and be functional and be 100%
functional and then take that uh uh
mapel upon Landing what sort of dose of
the mafel is that immediately upon
waking yep right and what sort of dose
any idea I I usually take 200 milligrams
if I'm going to take it but mafel can be
dosed typically the low end is 100 and
the high end is 600 okay uh what about
aranel I've heard about that comparable
right y same thing yep what is I'm
you're speaking to someone that's never
taken maphil what's the sensation of it
like uh it depends on the individual so
I perceive nothing I'm just more awake
and I'm I feel fantastic but I don't get
a high from it I don't get any
stimulation from it I know there are
some people I can't tell you what
fraction of people but but a non-trivial
fraction of people actually experience a
negative sort of stimulation effect from
it what mean oh like they feel like uh
it probably feels like what a fedra used
to feel like back in the day oh it's
rushy yeah wow yeah now now again I
would argue that in those people they're
simply taking too much and that they're
very sensitive to it and they might get
the benefit without that negative side
effect if they down the dose my wife for
example can't take it but that's
probably because she's only ever tried
200 and I would bet if she ever really
needed it I'd probably give her 50 or
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