How to Make Sense of the Constantly Shifting Info on the Coronavirus | Tom Bilyeu & Peter Attia

all right what's up everybody we're gonna be talking to the extraordinary dr. Peter Atia today I'm very excited to bring him to you guys he is somebody that we've had on the show a few times he's also somebody that I know personally and I think he's a super extraordinary dude so he'll be giving us some insights into kovat 19 what's going on from a medical perspective what's going on in the healthcare system what we can do to protect ourselves all that good stuff so yeah he should be joining us any minute again we're gonna be joined by dr. Peter attea today if you guys haven't seen the episode episode or episodes I can't remember if we've had him on multiple times or not but just a super extraordinary guy I've known him now for many years Wow and is just an incredible incredible thinker he is he's done an amazing TED talk too by the way so yeah super super smart guy very well-versed in all things medicine related the human body longevity all of that stuff he's also an extraordinary concierge doctor so he works with a lot of people doing some pretty in-depth analysis of the human body and what it responds to in terms of living a high quality life for as long as humanly possible and so he is gonna be joining us this morning thank you so much for joining us today and I imagine you're doing this all day long now with people given your expertise and how have you been approaching learning about Kovan 19 well I mean you know luckily we've got a research team that's sort of spent the last whatever five six years thinking about longevity which is completely unrelated to this but at least we have the infrastructure in place of a team that can be basically redirected so it's super hard I mean we have to basically pivot every other day and if I think about what we've learned in the last four weeks it's it's it's staggering and if I also think about how many times we thought we knew and understood something only to realize a few days later no that's probably not correct so we have many different things that we're pursuing and and on top of that we've got people who are now volunteering to help us we've got you know guys that work at hedge funds that would normally be modeling you know market scenarios that are saying how can we help and so now they're helping build the models that we're using to try to understand spread and we've got other people who you know you know medical students pre-meds that normally you know do volunteer work that are saying hey how can i help contribute to these efforts with respect to doing research so it's it's been in that sense it's been actually quite humbling to see how much people just want to help that's that's actually really extraordinary and look there's I wouldn't wish this on anybody but watching people come together seeing the outpouring of people really trying to help make other people's lives better is it's a pretty cool response so walk me through you've talked about how a day in the life of kovat 19 is like a month em anywhere else what if what if we learned in the last couple days that maybe we didn't understand before like you were saying that people should be aware of well I mean I think we are probably seeing that there is some evidence of lasting immunity so that's one piece of good news is that people who are recovering from this based on some animal data at least should have some protection at least for the year coronaviruses are kind of different viruses and they we generally don't get lasting immunity from them the mild ones at least we you know people did get lasting immunity from the really severe ones that caused SARS in oh three oh four and MERS this is probably gonna be somewhere in between that's going to probably become relevant over the coming year I think the other thing that we're learning is that we still don't really have an effective drug strategy that's been truly vetted in other words we have lots of anecdotal stuff we have a lot of what's called off-label use and open label use which means things that are being tested but without random as control trials that look somewhat safe and somewhat promising but the reality of it is we don't yet have a fully vetted strategy around drugs I think the other thing we're seeing is that you know New York does probably look like it's headed for a real stress on its healthcare delivery system our view a week ago today was that it would probably happen within one to two weeks which means sometime this week you know our projections if they were half right would suggest that there's really going to be a mismatch between how many people need medical care in New York and how many don't the data as of last night were basically about a thousand deaths in New York but they're disproportionately in the borough's so how does one interpret that well we interpret that to mean that the people in the borough's were the most affected to begin with because they were probably the ones that were most in the subways commuting into and out of the city so actual deaths in Manhattan of those thousand were probably less than 200 so it's still I think a bit too soon to say but unfortunately if I had to guess I think the number of infected people in New York is is much higher than we realize now and so what can people be doing to protect their immune system or is that sort of a joke and don't even focus on that just focus on isolation what what's the best strategy right now for staying safe I think it's all of the above I I do think that there's probably nothing that beats you know robust social distancing both at the individual level and obviously at the the societal level for the short term we're seeing the economic consequences of that are probably much more grave than certainly than I expected or understood I felt for this realization and talking with a bunch of people and you can think about this because you understand how businesses work I'm sure your listeners do as well there's there's probably no business out there that's ever modeled zero revenue as a scenario you know when you're scenario planning you know you might say well you know really go badly you know maybe we'll see a 20% reduction in in revenue but but there's no such thing as well why don't we just model six months of no rest like that that's never been done right so so that you know I say all that to say like I don't take this idea of social distancing lightly but you have to be able to put this virus back on its heels and a big part of that is is sort of stopping the spread of a virus that really if you were designing a virus to be maximally destructive you would definitely take a few things from the Tsarskoe V twos playbook it's not the most deadly virus in the world you know in other words this is not a virus that wipes our species off the planet but if you wanted to make such a virus you would absolutely take some things that this virus does namely that it can be very infectious long before you are symptomatic that's a very powerful tool and a viruses toolkit to spread so going back to your question look I think that the most important thing people can do for their immune system is sleep I think of all of the levers we pull you know getting eight hours of sleep a night is going to move the needle as much as any I think other things that matter are exercising every day but not doing it at at super high intensity so kind of two types of people right there are people that don't exercise enough generally they need to be exercising more and then there are probably people like you and I who exercise a lot and probably exercise a little too much and a little too intense we have to actually dial it back so I'm you know really focusing on exercising every day but only about an hour and not at the level of intensity that I would normally and you know a lot of it's just body weight stuff it's just sort of moving it's just being active and it's as important for my head as it is for my my body with respect to food that's been a huge challenge for me you know I tend to stress eat a little more than I would care to admit so I've been kind of just focusing on doing more time restricted feeding it's just a little easier for me to be binary and you know at least say okay how about I just don't eat anything for these 18 or 20 hours as opposed to well allowing myself the liberty of stress grazing yeah that that I was actually thinking about you the other day I remember the story that you told about if you have if I remember I was cashews to have cashews in the house they have to be hidden and you can't know where they are and I thought well what's he doing in lockdown where it's like the either to not have anything that you want and and it be psychologically taxing in that way because you just can't have anything delicious in the house or like does he have to go hide while his wife pulls it out of hiding so he he doesn't see like what part of the house she goes to was just nice my littlest kid is potty training right now and his reward is M&Ms every time he goes you know peepee on the potty he gets his M&M and the problem is I was just eating them by the handful every time I walked by and I would rationalize it by saying well look I'm using the potty so loud so yeah we finally had to put the kibosh on that so the M&Ms are in hiding I don't get to know where they are and that's the way it is as far as you know I get asked a lot about supplements and stuff and I saw some people are asking questions about supplements I think at this point you know there's reasonable evidence that zinc is probably worth taking the challenge of course is in what format so zinc is not necessarily the most bioavailable thing depending on how you take it but you know you're generally going to need about I don't know call it you know 30 to 50 milligrams of a relatively bioavailable zinc the lozenges which are typically pretty good have been kind of sold out on Amazon for quite some time so you know zinc supplementation probably makes a little bit of sense you know as far as anything else I think it's just too hard to say and my concern with it is I wouldn't want to give somebody a false sense of confidence that because they're taking you know vitamin C or vitamin D which also is probably quite important especially if you can't get out into sunlight so you know people who live in parts of the country or the world where they can still despite a quarantine get out and get sunshine I think that's hugely important to get vitamin D in the natural way if people can't then I think supplementing vitamin D would also matter but again you just don't want people to think that that protects them from washing their hands and things like that yeah and of course distancing from you know people who themselves are not able to quarantine so going back to the notion that you were talking about with be a little bit careful about definitely be careful about under working out but you actually have to be careful about over working out so I have a regimen I take cold showers every day I work out every day I intermittent fasting day I would love to stop all of them so you've already addressed the working out what about cold showers what about intermittent fasting what about prolonged fasting where we're in that sort of do hard things um to prolong your life regimen do we find that we might be cracking over into creating too much of a stress response so let's look at the one area where we have the most data on that tom is exercise so it's been clearly studied the different types of exercise and how they trickle into a stress response so remember everything that you just described is a short term stress or hormesis that is meant to produce a long term adaptation that is beneficial right so exercise is stressful right exercise breaks down muscle it taxes the body and it's our response to that that is beneficial so when we look at exercise and we look at sort of modest low intensity aerobic exercise we observe that the immune system transiently actually gets stronger not weaker as a result of that conversely when we look at studies of high-intensity interval training we find a transient reduction in immune system before a bounce-back and again that's probably because that high intensity training causes an overabundance of stress in the short period of time and while that produces great physiologic benefits down the line I think we have to figure out what we're optimizing for it in this moment are you optimizing to be the fittest version of Tom or the healthiest version those aren't necessarily the same thing so how do we extrapolate that to fasting because that's something I think a lot about well I think we also know that prolonged fasting you know three four or five seven day fast actually raise cortisol levels they're actually quite stressful in the short run because evolutionarily when you know our ancestors didn't eat for three days that was a bit of a kick in the butt to go out get food be more efficient you know we we require less sleep during periods of intense fasting in part for that reason so for that reason I just I just don't think this is the time to be doing prolonged fasting you know I think the typical three to seven day fast that I do you know with great frequency I'm just going to be holding off on those until I have a little bit more clarity that said there's no evidence that short term you know time restricted feeding is problematic and I think in many ways timer triggered feeding is an efficient way for us to manage if you're someone like me stress eating if you're just looking to have a little bit control I mean you know yesterday I did a nomad which I haven't done in a while and I just felt a lot better than I felt during the sort of grazing of food all day which is what Sonoma - sorry one meal a day so I just had you know dinner Sunday dinner Monday I'll probably just do it again today I won't eat it until I have dinner tonight that's kind of a long time restricted feeding yeah for sure and what do you think about cold exposure where do you fall on that yeah I've looked a lot into cold exposure and heat exposure for different reasons my cold exposure is quite interesting really the data on cold exposure so I think two reasonable lines of benefit the first is it clearly has a benefit in what's called delayed onset muscle soreness or Dom's so if people use cold exposure as a way to recover from training it definitely shows an improvement in symptoms there but of course given that we're not going to be training to the point of crushing ourselves it's not clear that that's as important I think the other area where cold immersion seems to be beneficial is probably from a neuro perspective I think there's reasonable evidence that there are some anti-depressive properties of cold immersion especially with respect to neurotransmitters that have anti-depressive benefits contrary to popular belief there's really a complete dearth of evidence staying that cold therapy boosts immune function reduces you know other types of inflammation or generally produce as much benefit I mean the benefits on heat therapy are much greater than cold therapy so I'm not I I guess I wouldn't say that cold therapy is necessarily harmful because I don't think you know it produces any downsides obviously mild cold therapy is also known to activate brown fat which is metabolically quite active and truthfully I it doesn't occur to me that that would necessarily be a bad thing or necessarily a beneficial thing so I guess long-winded answer would be if cold therapy helps you feel better like literally for some people I think it is just an amazing antidepressant this would be a great time for it because I think for many of us right now the sort of anxiety and uncertainty of what's going on is itself a burden I've seen one thing go through the comments a lot which is people wanting to know if a multivitamin is something that will be useful I'm assuming if it doesn't contain zinc that it's probably zinc and vitamin D where as you were talking sort of the two things I took away as maybe being the most important but is there a multivitamin that you recommend or is it a way no I think I think multivitamins are not great because they basically have too little of the things you want and generally more of the things you don't care for so I my view is if you're going to supplement something if you if you believe that you can't get enough vitamin D from sunlight then you really probably need to just be taking straight-up vitamin d3 and you know probably 2 to 5,000 IU is the sufficient similarly if you're not getting enough vitamin C in your diet you know you probably ought to just fully supplement vitamin C and if you're not getting enough of the B is b6 b12 folic acid you know again if you again this is an important point to consider right there are many people who aren't able to get fresh foods the way they once would so again those are times when you want to turn to supplementation but my view is go directly for the supplement as opposed to the multi I don't never really understood the value of multivitamins except for marketing very fair so in in a time of limited access to foods if we were going to try to do it all through foods which I certainly will do my best I try to get sunlight as close to everyday as humanly possible I'm very fortunate to live in Los Angeles where it's not exactly a hardship to even just like stick your head out of window and I've tried to revisit so obviously I'm in a fortunate position now where it's much easier to deal with being in a quarantine I'm trying to revisit like what this quarantine would look like at the different phases in my life when I was dirt poor didn't even have a balcony you know it was like but there was one window in the house you could wind open in the kitchen and it's like you know could if you legitimately could not walk out your front door could you at least you know stick your head out the window the importance of getting fresh air but anyway that's that sort of a cyclone what I really wanted to ask was if we were going to try to do all of this without supplementation what are the things like should we be getting red meat because I know that red meat contains all the vitamin C that you're going to need should we be eating certain leafy greens like what are the like four or five things if we know that we only have access to a limited number of sort of widely available things what would that selection be well I mean you know we have to be careful about assuming we can get enough vitamin C and meat that's really only true if you're not consuming carbohydrates with it so in the case of like the Inuit and the Masai who are basically just eating meat you're right they could get trace amounts of vitamin C in there but because they didn't have any glucose in their diets it was sufficient but if one is you know eating meat and potatoes but not eating you know anything that's citrusy lemons oranges things like that they're probably not getting enough vitamin C and they might want to supplement it with respect to vegetables you know we've taken a cautious principle internally in our practice now and recommended the following to our patients most of us of course are getting groceries delivered intermittently if you're not you know lucky enough to have a garden where you can grow your own stuff we take this idea pretty seriously that you want to be able to assume that any piece of food that comes in your is carrying a virus on it and the good thing about this virus is we know that it's quite susceptible to soap and water you know it's not like a virus that is unkillable but you've got to be able to you know scrub it with soap and water so things like lettuce berries things where the surfaces are just not amenable to a full cleaning we're just kind of avoiding and you know you've heard me joke about how much I love salad every day I need a salad in a bowl the size of my head so that salad has morphed so that salad now is which used to be a very leafy sort of salad is now basically tomatoes cucumbers carrots and bell peppers which are basically all things you can completely wash cut up a little olive oil lemon juice in a way we go so that's kind of a pivot that I've made on that front and then if you know it's also sort of you know relying on so so far less fruit than normal and you know again we're fortunate from a meat standpoint because I hunt and we've got a freezer that's just sort of stockpile you know venison but again I sort of think like it's the biggest issue with respect to food is like trying to minimize the destructive eating I think it's you know I don't think this is a time to make enormous dietary pivots right if somebody normally likes to eat red meat great keep eating it but you know make it the highest quality that you're able to get and acknowledge that any port in the storm means like half the time when we look at instacart or whatever we're using the ordering like you just can't get what you want sometimes so you know you sort of pick and choose your battles the other thing I want to come back to that I I really hope to have a better bead on within the next two weeks is what is going to be the availability of protective masks because as we go to the point that you raised you're someone who lives in a tiny apartment building in New York you barely have a window to look out you know what is it going to mean for your sanity to be able to get outside well I think it's gonna need a hell of a lot and I think the evidence is emerging rapidly in the past few days that you know that the proper type of mask is truly protective now again a month ago the message was no this is not the case and I think there's been some real bungling of this through through through some of the the sort of political responses to this but I but I think if you really look at the proper use of an n95 mask I think it is both a great tool to protect a person who's wearing it from others and to protect others from the person wearing it in other words I think there really is emerging evidence that if we were all gonna walk around with masks outside and take great precaution we could start to mobilize a little more than we are so what I'm hoping is we get to a point where the production of those masks is ramped up now 3m which is the leading manufacturer of the n95 masks is able to make I want to say 35 million of those masks a month so we maybe it's a week and of course it matters greatly the point is whatever they're able to make right now is probably gonna take us a while to have a sufficient number of these things that's a week so so we've we've you know I think we're still early in the days of knowing that everybody can have sufficient access to these things and obviously you have to prioritize who gets them first and nobody needs them more than health care workers but I do hope that you know a month from now we're sitting having this discussion when everybody's got an n95 mask and that is opening up the door for them to actually get outside and start to interact with the world again because I I think that's you know listen it's a real you know challenge for everybody that's in quarantine yeah mental health is obviously with what I do and the thing that I guess I know about in terms of dealing with the public that's that's been huge a lot of questions around that and I think that there's going to be a lot of it it isn't as much of a part of the public discourse in terms of this effect on people's psychology we don't have a lot of time left with you so what I want to ask is there anything that you think that people can do during quarantine to optimize for that whether that's to hey do bodyweight workouts because of the you know BDNF and things that are going to help you pull yourself psychologically or physiologically out of a bad psychological state or is it just some is there any optimistic news that you can impart around what's going on with kovat nineteen that would be amazing you know there is you point of time we're putting out podcasts at a great clip right now far more than our normal clip and every podcast we put out in the last three weeks including one that's going to come out today I mean they're just exclusively geared to this none of the content is behind a paywall and I would just kind of direct people to that so for example you know interview I had with Ryan holiday a week ago is just a great you know really dealing with the psychology of this stuff in fact we've had two episodes one win Sam Harrison one with Rick Elias I mean that pardon me with Ryan holiday that have just dealt with sort of these questions and you know one of the things that Ryan brought up that I really liked was the you know the difference between dead time and a live time so you know you we don't have much control over the fact that we're all kind of corn but there's a way to sort of take that situation and make something great of it and and look it's tempting to say maybe I'm just going to sit here and watch Netflix all day long but that's kind of dead time right and so maybe you know watch Netflix for an hour a day but spend time reading completely unplugging from the situation and going through those novels you have not had the time to look through or you know picking up a hobby like you know there are other little goofy things I'm trying to make time to do everyday that don't seem to add much value to my immediate life they're a great distraction you know we talk a lot about Winston Churchill on this podcast and how he kind of coped with this never-ending stress of you know the Second World War and how despite that he's done still found time to be still so I do I think that the the mental health component of this time is enormous and it's only going to get more important as time goes on and in fact I was reading an article this morning that talked about the psychological fallout of each of the previous pandemics from the 1918 flu to SARS MERS and h1n1 and actually it's very disturbing some of the lingering trends we see both in health care workers who face protracted burnout following these things and also a number of the people who have been in quarantine and then all of a sudden start to develop phobias that make it harder for them to go out even when the quarantine is over so I'm glad people are paying attention to this now because I think it's going to be an enormous area of of attention it's going to need to be an enormous area of attention regardless of how this thing resolves yeah so that word attention I think is is super critical for people to hear your whatever you point your attention at you're going to see more of and look this is this is certainly not an easy time but the only thing that I think is gonna make it worse for people is if you focus on all of the negative if you focus on all the ways that things are going wrong we started a podcast or whatever this is the IG live by talking about you know some of the ways that people are coming together and the ways that people have been offering their assistance you for free just to like help you model things out people that in any other time certainly in our lifetimes would have been pointed at you know something else something probably revenue-generating and you know there there really is this cool other thing happening that is people doing their best to reach out to connect to find excuse me find ways to do things with their time like you said to make it more a lifetime so I'm super interested in that and I think that trying to get people to understand that they control their attention and what it gets aimed at will be huge I I hadn't thought of Winston Churchill in this context but that's actually really interesting and there's a forget I said it but there's a quote about meditation which is if you don't have ten minutes to meditate you're the person who needs to meditate the most and I think that that's really true and for people to take time to really begin to you know get their head in the right place is going to be pretty critical I've heard you talk about how you've been a little more irritable through this what have you done to deal with that what are you doing to focus yourself on something that stays in a more positive direction I'm trying to be more attentive to my emotions so I tend to suppress them and ignore them and they only become apparent when I'm about to erupt so it's like I sort of live on an emotional binary scale I'm digitally emotional like zero one zero one and I'm trying to be more analog right like a rheostat so that means you know when my kids are just completely driving me bananas I try to hit a pause a little sooner in the process and say is it really upsetting you that they're doing this or that or are you actually upset about something else and you're starting to displace your tension towards them it's actually made a really big difference I mean that sounds like a very cliche thing to do but this very deliberate focus on doing what's called an emotional check-in has been really powerful and ever since I had that really bad couple of days where I was just like kind of losing my mind and flipping out at the kids over seemingly nothing these these very frequent emotional check-ins have been a helpful way to do it and of course if you can do it with somebody if you can do it with your spouse and doesn't have to be somebody in person I think that's a really valuable thing to do it's just to be able to say look man I feel scared today like and every day I sort of my wife asks for my sort of temperature you know how are you feeling today and I'm like you know some days I'm like I'm totally optimistic like we're gonna you know this is gonna happen is gonna happen there's other days I'm like like last night I was just really depressed and I went to bed and I was like this is gonna be a disaster and and and again neither of those extremes are likely true but how you feel definitely impacts how you color the world yeah that that is for sure well my friend thank you so much for joining me dude it is always awesome to connect with you and spend a few minutes together your insights are absolutely extraordinary thank you for being on the front lines of this for making so much your content available to everybody there resources that you have at your command not the least of which your own mind is is unbelievable man and I am super excited that I live in a world where you're putting out this content it's a game changer so thanks for showing up thanks for talking people through this difficult time and hopefully I will connect with you soon thanks man be well all right same everybody out there be safe take care of yourself wash those hands get some sunlight eat right exercise a little bit but not too much and we will get through this I promise keep your head right everybody all right peace out take care