Optimizing Investing, Blood, Hormones, and Life (Podcast Double-Header: #63 and #65)

Discussing life and investing with Mark Hart and Raoul Pal.

[DISCLAIMER: I’m not a doctor, nor do I play one on the Internet. Speak with a medical professional before doing anything medical-related, m’kay?]

There is something here for everyone.

This post details two jam-packed discussions  — one with world-renowned macro investors and investment strategists (Mark Hart and Raoul Pal), and another with a top performance doc you’ve referenced hundreds of times (Peter Attia, MD).

In both, we address dozens of topics, including:

– How do you choose an optimal investment style?

– What’s the most useful definition of “ROI” for lifestyle purposes?

– What are the 5 lesser-known physical tests you should consider?

– How does hormone therapy fit into the bigger performance and longevity picture (or not)?

– Productivity and exercise/diet tips from all participants.

Below, you’ll also find the most comprehensive show notes and links I’ve done to date. They’re DEEP.  If you like them, please let me know in the comments, as these take a TON of time to transcribe and summarize.

EPISODE 63 — I am interviewed by Mark Hart and Raoul Pal for Real Vision Television, which was created to combat the dumbed-down approach to finance in traditional media. Mark predicted and bet on the subprime mortgage crisis, the European sovereign default crisis, and more. As Forbes put it, related to Mark, “Sometimes, combing through a mountain of manager letters felt like reading the newspaper years in advance.” We talk about nearly everything in this roundtable.

• Listen to it on Apple Podcasts
• Listen to it on Spotify

You can find the transcript of this episode here. Transcripts of all episodes can be found here.

EPISODE 65 — Peter Attia, MD, answers your most popular 10-15 questions (e.g. top blood tests, hormone therapy, increasing VO2 max, long-term ketosis, etc.), as voted on by thousands of you. Peter is President of NuSI and a tremendous endurance athlete in his own right.

• Listen to it on Apple Podcasts
• Listen to it on Spotify

You can find the transcript of this episode here. Transcripts of all episodes can be found here.

This podcast is brought to you by Mizzen + Main. Mizzen + Main makes the only “dress” shirts I now travel with — fancy enough for important dinners but made from athletic, sweat-wicking material. No more ironing, no more steaming, no more hassle. Click here for the exact shirts I wear most often. Order one of their dress shirts this week and get a Henley shirt (around $60 retail) for free.  Just add the two you like here to the cart, then use code “TIM” at checkout.

This episode is also brought to you by 99Designs, the world’s largest marketplace of graphic designers. Did you know I used 99Designs to rapid prototype the cover for The 4-Hour Body? Here are some of the impressive results.

QUESTION(S) OF THE DAY: What is the best investment advice you’ve ever read or heard? Please share and explore answers in the comments here.

Do you enjoy this podcast? If so, could you please leave a short review here? I read them, and they keep me going. Thanks!

And here are the copious show notes and links for both episodes…

Part 1 – Investing and Life Optimization – Episode #63 (Links and Time Stamps)

• Listen to this episode on iTunes
• Stream by clicking here

People Mentioned

• Josh Waitzkin
• David Allen
• Ben Franklin
• Marcus Aurelius
• Peter Drucker
• Michel Thomas
• John Smith (Oklahoma State Olympic wrestler)
• Paul Tudor Jones
• Mark Twain
• Socrates
• Ray Cronise (NASA researcher)

Companies Mentioned

• 23andMe 
• Navigenics
• Headspace (meditation app)
• Calm (meditation app)

Books Mentioned

• Outliers by Malcom Gladwell
• Exploring the World of Lucid Dreaming by Stephen LaBerge
• Mastery by Robert Greene
• What I Learned Losing $1 Million by Jim Paul
• The Art of Learning by Josh Waitzkin

Selected Links from the Episode

• Uric Acid
• Glycemic Index
• Maslow’s Hierarchy of Needs
• Adiponectin Hormone
• Transcendental Meditation
• Vipassana Meditation

Time Stamps

• Raoul sets the stage for the conversation [3:33]
• Tim discusses his background [4:13]
• Mark discusses his background [5:30]
• How Tim approaches productivity improvements [8:15]
• How Mark implemented Tim’s advice [11:15]
• Establishing a baseline for self-tracking [13:20]
• Hacking 10,000 hours to mastery [17:05]
• How to hack breakfast [21:25]
• How to hack insomnia [22:35]
• Hacking cheat meals [23:25]
• Genetics testing [25:10]
• Thoughts on time management [26:10]
• Cold (ice bath) and heat (sauna) therapy [31:03]
• Lucid dreaming [34:35]
• How to find out what you are good at [39:30]
• On Journaling [41:55]
• Feeding your subconscious mind [45:10]
• Tim’s calling [47:50]
• [On constantly improving [52:23]
• On enjoying the journey [56:00]
• Psychological dynamics of making or losing money [57:34]

Key Takeaway Show Notes

How to Approach Productivity Improvements

There are a number of ways to try and improve the performance of a company, group of people, or single person.

If you look at it like rally car racing, you have a racetrack that is designed to kill you.

• It is not designed to be as safe as possible. The path is somewhat known, but the terrain is unknown (it could be raining, sleeting, etc.)

People tend to have this separation of mind and body, but at the end of the day you have certain levels of neurotransmitters that are produced and depleted at a certain rate, and that is the rate-limiting step in your mental performance.

• If you want to have better levels of working memory and sustained attention, etc – you can optimize those by optimizing the car (i.e. the body in this case).

There are also process things like what are the daily habits and ways you approach turning your effort on or off for productivity and recovery throughout the day that you can tweak.

• This would be the example of driving the car.

On Self-Tracking

You want to establish a self-tracking baseline.

• You don’t want to make health decisions on once-annual blood tests because if you took that test the very next day the values would be different.

What you are interested in (in terms of blood values) is not just a snapshot in time, but rather you want to understand the trends.

Journaling is also a good way to establish a baseline in terms of a daily and weekly routine to identify what led you to states of flow or what 20% of activities / people are producing 80% of your negative emotions / bad decision-making.

On Hacking

There are many ways to circumvent the 10,000-hour rule for almost any skill.

• Study the anomalies rather than discarding them as outliers.

One easy hack is to have 30 grams of protein within 30 minutes of waking up (lentils, spinach, and two whole eggs for example).

• By doing this, it is not uncommon to lose 20 pounds in the first month if you have 20% body fat (if you are a male).

If you have trouble sleeping, it is often due to low blood sugar.

• You could have a tablespoon of unsweetened almond butter before you go to sleep, and you will see a lot of people who are chronically fatigued fixed immediately.

If you have to have a cheat meal you could have a tablespoon of vinegar before the meal, which will help lower the glycemic index (your glucose response to that meal).

On Time Management

Time is one of several currencies.

• A currency is something you trade for something else.

Time is non-renewable, whereas capital is renewable.

In the hierarchy of prioritization (past a certain point of Maslow’s needs), time should take priority.

If you don’t have time it is an indication of not having sufficiently clear priorities.

On Cold (Ice Baths)

Cold exposure can improve immune function, serve as anti-depressant therapy, and effects hormones like adiponectin (which leads to increased rate of fat loss in many cases).

On Lucid Dreaming

You can further reinforce or develop your skills while you’re sleeping during lucid dreaming.

• Lucid dreaming not only improves performance, but also helps you develop present state awareness.

On Journaling

Journaling has tremendous value, especially if you don’t view yourself as a writer.

Writing allows you to freeze your thoughts in a form that you can analyze.

You should write down your fears and worries, and explore them. This will clarify what they are.

• Sometimes they will end up unfounded, and you can remove them as an influence.
• Other times it will clarify how those risks can be mitigated.

Part of the value is taking these muddy distractive thoughts and imprisoning them on paper so you can get on with your day.

On Constantly Improving

Seeking constant improvement and dissatisfaction do not have to go hand-in-hand.

• If you aren’t getting stronger, you are getting weaker.

The way you reach equilibrium, or the sensation of balance, is by having appreciation and a set of activities and practices for that.

On Enjoying the Journey

At the end of the day you have to focus on the process because, due to good or bad luck, you can get a bad result after a very good process or a great result after a very bad process.

• You can also help avoid depression that can come from bad outcomes by enjoying the process.

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Part 2 with Dr. Peter Attia – Episode #65 (Links and Time Stamps)

• Listen to this episode on iTunes
• Stream by clicking here

Medical Terminology –

• APOE Genotype
• LDL Particle Number
• LP(a)
• OGTT (Oral Glucose Tolerance Test)
• IGF-1 (Insulin Growth Factor 1 Level)
• Desmosterol
• Hyperinsulinemia
• Metformin
• AMP Kinase
• PCSK9
• Homocysteine
• C-reactive protein
• Uric Acid
• Cirrhosis
• Metabolic syndrome
• Ketogenic diet
• VO2 Max

People Mentioned

• Elizabeth Holmes
• Gerald Reaven

Companies Mentioned

• Theranos
• Health Diagnostics Laboratory
• Nutrition Science Initiative (NuSI)

Books Mentioned

• Getting Things Done by David Allen

Time Stamps

• What are the top 5 biological tests everyone should get? [4:53]
• Should you eat carbs following weight training to promote anabolism within the muscle? [12:00]
• What are the top 10 supplement recommendations? [15:11]
• Should the ketogenic diet be a short-term intervention or a long-term lifestyle? [20:48]
• Blood testing at home [28:45]
• Should you not drink alcohol? [32:40]
• The results of Peter’s insulin suppression test [38:45]
• How do you figure out if a ketogenic diet works for you? [47:30]
• What type of cardio is best for you? [50:54]
• When can we expect results from the energy balance consortium? [58:05]
• Testosterone replacement for men [1:00:00]
• How Peter maintains his productivity [1:06:22]

Key Takeaway Show Notes

What Are the Top Five Biological Tests?

This answer depends on an individual-by-individual basis and the risks each person faces (cardiovascular disease, cancer, etc.)

Through the lens of preventing death these five tests are the most important:

1. APOE Genotype – helps us understand what diseases you may be more (or less) at risk for.
2. LDL Particle Number via NMR (technology that can count the number of lipoproteins in the blood) – counts all of the LDL particles, which are the dominant particles that traffic cholesterol in the body both to and from the heart and to and from the liver. We know the higher the number of these particles the greater at risk you are for cardiovascular disease.
3. LP(a) via NMR – This is the most atherogenic particle in the body. If this is elevated (independent of the LDL particle number) it is an enormous predictor of risk and something to act on indirectly (diet and drugs don’t seem to work as effectively in mitigating this).
4. OGTT (Oral Glucose Tolerance Test) – This is a time 0-hour, time 1-hour, and time 2-hour test that looks at insulin and glucose. The 1-hour mark is where you may see the early warning signs with elevated glucose levels (anything over 40-50 on insulin), which can represent hyperinsulinemia (a harbinger for metabolic problems).
5. IGF-1 (Insulin Growth Factor 1 Level) – This is a pretty strong driver of cancer. Diet can help keep IGF-1 levels low.

Should You Eat Carbs Following Weight Training to Promote Anabolism Within the Muscle?

It depends what you are optimizing for.

If your primary objective is to increase you muscle size, then yes there is a benefit to consuming carbohydrates and / or whey protein.

However, if you are someone like Peter who could care less about the size of your muscles then the answer is no you should not do that.

• Peter doesn’t even consume whey protein post workouts anymore because he is optimizing for longevity and using caloric restriction as one method for that.

What Are the Top Supplement Recommendations?

There are few things everyone should take across the board unanimously.

• It is highly individualized based on your needs and goals.

Peter takes:

• Vitamin D
• Baby Aspirin
• Methylfolate
• B12
• B6
• EPA
• DHA
• Berberine
• Probiotic (which he cycles on and off of)

He takes all of these because he is managing to certain targeted levels for all of these markers that he can’t get to without supplementing.

Peter does not take:

• Multivitamin
• Vitamin A
• Vitamin K
• Vitamin C
• Vitamin E

Should the Ketogenic Diet be a Short-term Intervention or a Long-term Lifestyle?

Peter is not sure, but questions the evidence of any society (for example, the Inuit culture) that has been claimed to have lived entirely on a ketogenic diet in perpetuity.

• However, this doesn’t mean that ketogenic diets cannot or should not be sustain long-term.

Nobody has done a long-term study of people on ketogenic diets.

• The data we do have is generally conflicting.

There is a lot of documentation on ketogenic diets being safe and effective, at least over the short-term (less than 1-year) for type 2 diabetes and obesity.

Peter spent 2.5 years in ketosis, but hasn’t been for a little over 1 year consistently.

• He does still get in ketosis once per week as a result of fasting, and he feels he is at his best on a ketogenic diet.
• The main reason to move away from it today for Peter was a craving he has had for more fruits and vegetables, which makes it hard to stay in a ketogenic diet.

Going forward he would use a diet that cycles in and out of ketosis, but it is less about him believing there is long-term harm in ketosis and more about him scratching other itches in experiencing a broader array of foods.

It is pretty clear when a ketogenic doesn’t work.

• When C-reactive protein, Uric Acid, homocysteine, and LDL Particle numbers go up it is clear that diet is not working for that person.

On Blood Testing at Home

What is interesting is what a company like Theranos is doing, which is creating a black box that allows you to use less than a thimble of blood and use that for a very broad array of testing.

• The goal may be to have these in places like a CVS where you can go in and put a finger prick of blood on a strip and get a wide array of testing.
• Legal hurdles could be a challenge here.

Should You Not Drink Alcohol

Peter has never seen convincing evidence that the addition of alcohol creates a health benefit.

For some people, ethanol alcohol, up to reasonable doses, has no harm.

• Other people are prone to having an inflammatory response from drinking even a small amount of wine or beer.

Peter recommends doing an elimination-reintroduction test.

• Knock alcohol out of your system for 1-month while making no other change, and then slowly reintroduce it.

What Type of Cardio is Best For You?

The type of cardio activity that puts an undue stress on the heart, in terms of cardiac output, is not ideal.

The heart has to expand (open much wider) to accompany the extra blood volume.

• If that expansion sustains for a long period of time it can result in deformation of the electrical system of the heart (particularly the right side of the heart as it is less muscular than the left).
• This can result in electrical system failures of the heart.

At very low levels of physical activity the outcomes are not good (people don’t live that long).

At medium levels of physical activity (30-45 minutes a session / 4 sessions a week / modest output) had the best outcomes where people lived the longest.

Really high levels of physical activity (greater duration / greater intensity) resulted in the curve falling down again.

Testosterone Replacement for Men

This is a complicated topic because we live in a society where somehow we have let morality get in the way of science.

Testosterone replacement is a viable option in men with whom levels are deficient and symptoms justify the use.

• The problem is we have this belief, which is not substantiated by rigorous science, that overstates the detriment of its use.

The data is not clear that hormone replacement in men results in an increased risk of heart disease.

• People are more willing to accept that testosterone replacement in men actually reduces the risk of prostate cancer.

The problem with all hormone replacement is that the numbers alone aren’t significant, which means you have to treat patients based on symptoms.

How Peter Maintains His Productivity

Peter is a big fan of creating to-do lists, and he carries physical cards with him for daily, weekly, and long-term professional tasks. He also carries a personal monthly to-do list.

• Writing these things down takes the stress out of it.
• Most of the anxiety is worrying you will *forget* something, not feeling overwhelmed about *doing* things.

The Tim Ferriss Show is one of the most popular podcasts in the world with more than one billion downloads. It has been selected for "Best of Apple Podcasts" three times, it is often the #1 interview podcast across all of Apple Podcasts, and it's been ranked #1 out of 400,000+ podcasts on many occasions. To listen to any of the past episodes for free, check out this page.