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    Discover Your Ebook From Our Huge Collection E-Books | বাংলা ইবুক (Bengali Ebook)

Ebook Tools Of Titans (2016) By Timothy Ferriss | Epub

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    5 BLOOD TESTS PETER GENERALLY RECOMMENDS
    “Of course, the answers depend on the individual and the risks each person faces (cardiovascular disease, cancer, etc.) based on family history and genetics, but—broadly speaking—looking through the lens of preventing death, these five tests are very important.”
    APOE Genotype: “This informs my thinking on a person’s risk for Alzheimer’s disease (AD). The gene is far from causal, meaning, having it does not cause AD, but it increases risk anywhere from a bit to a lot, depending on which variant you have and how many copies you have. For what it’s worth, the apoE phenotype (i.e., the actual amount of the lipoprotein in circulation in your body) is more predictive of AD than the gene and is obviously a better marker to track, however [a test is] not yet commercially available. Stand by, though. I’m working on it.”
    LDL Particle Number via NMR (technology that can count the number of lipoproteins in the blood): “This 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 [that] the higher the number of these particles, the greater your risk of cardiovascular disease.”
    Lp(a) (“L-P-little-A”) via NMR: “The Lp(a) particle is perhaps the most atherogenic particle in the body, and while it’s included in the total of LDL particle numbers, I want to know if somebody has an elevated Lp(a) particle number, because that, in and of itself, independent of the total LDL particle number, is an enormous predictor of risk. It’s something we have to act on, but we do so indirectly. In other words, diet and drugs don’t seem to have any effect on that number, so we pull the lever harder on other things. Nearly 10% of people have inherited an elevated level of Lp(a), and it is hands down the most common risk for hereditary atherosclerosis. The bad news is that most doctors don’t screen for it; the good news is that knowing you have it can save your life, and a drug (in a class called “apo(a) antisense” drugs) to treat it directly will be around in approximately 3 or 4 years.”
    OGTT (Oral Glucose Tolerance Test): “In this test, you drink a glucose concoction and then look at insulin and glucose response at 60 minutes and 120 minutes. The 1-hour mark is where you may see the early warning signs with elevated glucose levels (or anything over 40 to 50 on insulin), which can represent hyperinsulinemia, a harbinger of metabolic problems. In fact, the 1-hour insulin response may be the most important metabolic indicator of your propensity to hyperinsulinemia and insulin resistance, even in the presence of normal ‘traditional’ markers such as HbA1C.”
    IGF-1 (Insulin-like Growth Factor-1): “This is a pretty strong driver of cancer. Diet choices (e.g., ketogenic diet, caloric restriction, intermittent fasting) can help keep IGF-1 levels low, if such a strategy is warranted.”
     
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    KETOSIS WARNING SIGNS
    “Keto works well for many people, but it’s not ideal for all. It’s also not clear why some people do well for long periods of time, while others seem to derive max benefit from cycling. If certain markers get elevated (e.g., C-reactive protein, uric acid, homocysteine, and LDL particle numbers), it’s likely that the diet is not working properly for that person and requires tweaking or removal. Some patients who suffer from significant LDL particle number increases on keto can reverse the trend by limiting saturated fat to fewer than 25 g and replacing the required fat calories with monounsaturated fats (e.g., macadamia nut oil, olive oil, limited avocado oil).”

    BEFORE YOU GET COMPREHENSIVE WORK DONE, DECIDE WHAT YOUR THRESHOLD OF ACTION IS
    “The likelihood of doing comprehensive testing and finding everything ‘normal’ is low, so don’t have testing done unless you’re willing to accept the uncertainty that comes from needing to make decisions (or not) with incomplete—and at times conflicting—information. Before you check your APOE gene, for example, you should know what you’ll do if you have one or two copies of the ‘4’ allele.”
    TF: Decide beforehand—and not reactively when emotions run high—what types of findings are worth acting upon or ignoring, and what your “if/then” actions will be.
    THE DANGERS OF BLOOD TEST “SNAPSHOTS”
    It’s important to get blood tests often enough to trend, and to repeat/confirm scary results before taking dramatic action. This has been echoed by other guests who have appeared on my podcast like Justin Mager, MD (page 72), and Charles Poliquin (page 74):
    “In 2005, I swam from Catalina Island to L.A., and I had my friend Mark Lewis, who’s an anesthesiologist, draw my blood around 10 minutes before I got in the water on Catalina Island and then 10 minutes after I got out of the water in L.A., 10.5 hours later. It was a real epiphany for me, because I had developed something called systemic inflammatory response syndrome, SIRS, which is something that we typically see in hospitalized patients who have horrible infections or who have been in really bad trauma: gunshot, car accident, that sort of thing.
    “My platelets went from a normal level to 6 times normal. My white blood cell count went from normal to—I don’t know—5 times normal. All of these huge changes occurred in my blood, so that you couldn’t distinguish me from someone who had just been shot. . . .
    “I’ve always been hesitant to treat a patient for any snapshot, no matter how bad it looks. For example, I saw a guy recently whose morning cortisol level was something like 5 times the normal level. So, you might think, wow, this guy’s got an adrenal tumor, right? But a little follow-up question and I realized that at 3 a.m. that morning, a few hours before this blood draw, the water heater blew up in his house. The normal level of morning cortisol assumes a guy sleeps through the night. He had to de-flood his house.”
     
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    4 BULLETS TO DODGE
    “If you’re over 40 and don’t smoke, there’s about a 70 to 80% chance you’ll die from one of four diseases: heart disease, cerebrovascular disease, cancer, or neurodegenerative disease.”

    “There are really two pieces to longevity. The first is delaying death as long as possible by delaying the onset of chronic disease (the ‘big four’ above). We call that the defensive play. The second is enhancing life, the offensive play. On that defensive play, there are basically four diseases that are going to kill you. In other words, if you’re 40 years old and you care about this, you’re probably not going to die in a car accident or homicide, because you’re out of that demographic. You’re less likely to die of X, Y, and Z. It turns out that when you look at the mortality tables, there’s an 80% chance you’re going to die from cardiovascular disease, cerebrovascular disease, cancer, or neurodegenerative disease, period.
    “If you remember nothing else, remember this: If you’re in your 40s or beyond and you care about living longer, which immediately puts you in a selection bias category, there’s an 80% chance you’re going to die of [one of] those four diseases. So any strategy toward increasing longevity has to be geared toward reducing the risk of those diseases as much as is humanly possible.
    “[For those who don’t know,] cerebrovascular disease would be stroke, and there’s two ways you can have a stroke. One is through an occlusion; the other one is through bleeding, usually due to elevated blood pressure and things like that. Neurodegenerative disease, as its name suggests, is degeneration in the brain. The most common cause of that is Alzheimer’s dementia, and Alzheimer’s is one of the top ten causes of death in the United States.
    “[Studies] suggest to me that there’s something about highly refined carbohydrates and sugars—and potentially protein, though it might be for a different reason—that seems to raise insulin, which we know, by extension, raises insulin-like growth factor (IGF). And we know that IGF is driving not just aging but also certainly driving a lot of cancers, though not all of them.”

    SUPPLEMENTS THAT PETER DOES *NOT* TAKE
    Peter consumes a fair selection of supplements based on his own blood work, so it’s highly personalized. He does not take, however, a number of the common ones:
    Multivitamin: “They’re the worst of both worlds. They contain a bunch of what you don’t really need and don’t contain enough of what you do need. It poses an unnecessary risk with no up side.”
    Vitamins A and E: He’s not convinced he needs more than what he absorbs through whole foods.
    Vitamin K: “If you eat leafy green vegetables, you’re getting enough. K2 might be a different story for some people, depending on their diet.”
    Vitamin C: “Most of us get sufficient amounts in our diet, and while megadoses might be interesting, especially for combatting viral illnesses, it’s not bioavailable enough in oral form.”
    He is a proponent of magnesium supplementation. Our ability to buffer magnesium with healthy kidneys is very high. He takes 600 to 800 mg per day, alternating between mag sulfate and mag oxide. He also takes calcium carbonate 2 times per week. Two of his favored brands are Jarrow Formulas and NOW Foods.
     
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    THE LOGIC OF LOW-DOSE LITHIUM
    Based on conversations with Peter, I now take low-dose lithium in the form of 5 mg of lithium orotate. The more I read epidemiological studies, the more I’ve come to think of lithium as an essential, or conditionally essential, element. 1 to 5 mg is enough to effectively ensure you are getting the high range of what is naturally occurring in groundwater in the U.S. As a primer, I suggest reading the New York Times piece, “Should We All Take a Bit of Lithium?”* From that article:
    Although it seems strange that the microscopic amounts of lithium found in groundwater could have any substantial medical impact, the more scientists look for such effects, the more they seem to discover. Evidence is slowly accumulating that relatively tiny doses of lithium can have beneficial effects. They appear to decrease suicide rates significantly and may even promote brain health and improve mood.
    And from Peter: “Lithium is actually really, really safe at low doses—basically anything below about 150 mg—if you have normal kidney function. It’s one of those drugs that got such a bad rap with the large doses that were sometimes needed to treat recalcitrant monotherapy bipolar disorder, but those doses—easily approaching 1200 mg—have nothing in common with the logic above.”

    MORE COMEDY—LONG AGO, WHEN PETER WENT FROM 170 TO 210 POUNDS, GAINING MOSTLY FAT
    “Frankly, I just got aggravated beyond words. We joke about it now, but at the time I literally said to my wife, ‘I’m going to go get a gastric bypass.’ And she said, ‘You are the most ridiculous human being who’s ever lived. We’re going to have to talk about our marriage, if that’s what you’re considering at the weight of 210 pounds.’ I actually did go and see the top bariatrician in the city of San Diego, and it’s kind of weird story because, even though I was obviously overweight, I was the thinnest person in the waiting room by a long shot. It put it in perspective. [I thought to myself,] ‘Peter, you think you’ve got problems. I mean, these people each weigh 400 pounds.’ And when it was my turn to see the doctor, the nurse took me up to the scale and weighed me. We got on the scale, and I’m like 210. She says, ‘Ah, this is fantastic. Are you here for a follow-up?’”
     
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    ON DROPPING RUNNING AND PICKING UP WEIGHTS
    “Nothing breaks my heart more than seeing that person who’s struggling to lose weight who thinks that they need to run 20 miles a week. They have no desire to do it, their knees hurt, they hate it, and they’re not losing weight. And I’d like to say, ‘Well, I’ve got great news for you. You don’t ever need to run another step a day in your life, because there’s no value in that.’
    “There is value in exercise, though, and I think that the most important type of exercise, especially in terms of bang for your buck, is going to be really high-intensity, heavy strength training. Strength training aids everything from glucose disposal and metabolic health to mitochondrial density and orthopedic stability. That last one might not mean much when you’re a 30-something young buck, but when you’re in your 70s, that’s the difference between a broken hip and a walk in the park.”

    PETER’S PATH TO MEDITATION
    10% Happier by Dan Harris is the book that got Peter meditating regularly. After limited success with open monitoring or mindfulness meditation, he was introduced to Transcendental Meditation by a friend, Dan Loeb, billionaire and founder of Third Point LLC, a $17 billion asset management firm.
    ✸ Most-gifted or recommended books
    Surely You’re Joking, Mr. Feynman! by Richard Feynman
    Mistakes Were Made (But Not by Me) by Carol Tavris and Elliot Aronson. The latter is a book about cognitive dissonance that looks at common weaknesses and biases in human thinking. Peter wants to ensure he goes through life without being too sure of himself, and this book helps him to recalibrate.
    ✸ Peter’s best $100 or less purchase?
    Peter has a monthly daddy/daughter date with his 8-year-old daughter. The below came up at the tail-end of one outing:
    “We were walking back to the hotel, and one of those rickshaw guys came up with a fully lit-up bike. I would normally never even think about hopping a ride on one of those things, but I could just see this look in her eye: ‘Wow, this bike has lights all over it.’ [So we hopped on.] This guy gave us a ride back, which probably cost $20, so not even $100. And, believe me, it’s $20 more than we should have spent to just walk back, but the look on her face was worth every dollar I have. I just got a little cheesy and cliché because old dads are like that, but that’s the best $20 I’ve spent in a long time.”
    ✸ Who do you think of when you hear the word “successful”?
    Peter mentioned several people, including his friend John Griffin, a hedge fund manager in New York, but I’d like to highlight his last answer: his brother. Peter’s brother Paul (TW: @PapaAlphaBlog) is a federal prosecutor, a great athlete, and father of 4 kids under the age of 5. He thinks an enormous amount about being a better federal prosecutor, and thinks just as much about how to be a better father. Peter elaborates:
    “Success is: Do your kids remember you for being the best dad? Not the dad who gave them everything, but will they be able to tell you anything one day? Will they able to call you out of the blue, any day, no matter what? Are you the first person they want to ask for advice? And at the same time, can you hit it out of the park in whatever it is you decide to do, as a lawyer, as a doctor, as a stockbroker, as a whatever?”
    * Anna Fels. “Should We All Take a Bit of Lithium?” The New York Times (Sept. 13, 2014).
     
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    PETER ATTIA
    Peter Attia, MD (TW: @PETERATTIAMD, EATINGACADEMY.COM) is a former ultra-endurance athlete (e.g., swimming races of 25 miles), compulsive self-experimenter, and one of the most fascinating human beings I know. He is one of my go-to doctors for anything performance- or longevity-related. Peter earned his MD from Stanford University and holds a BSc in mechanical engineering and applied mathematics from Queen’s University in Kingston, Ontario. He did his residency in general surgery at the Johns Hopkins Hospital, and conducted research at the National Cancer Institute under Dr. Steven Rosenberg, where Peter focused on the role of regulatory T cells in cancer regression and other immune-based therapies for cancer.

    PETER’S BREAKFAST
    “It usually starts with nothing, and then I usually do a second course—because I’m a little hungry—and I’ll have a little bit more nothing. I usually top it off with a bit of nothing.”
    Peter rarely eats breakfast and has experimented with many forms of intermittent fasting, ranging from one meal a day (i.e., 23 hours of fasting per day) to more typical 16/8 and 18/6 patterns of eating (i.e., 16 or 18 hours of fasting and only eating in an 8- or 6-hour window). Going 16 hours without eating generally provides the right balance of autophagy (look it up) and anabolism (muscle building).
     
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    RANDOM BITS
    Peter spent 3 straight years in nutritional ketosis, and maintained a high level of performance not only in ultra–long distance cycling and swimming, but also in strength (e.g., flipping a 450-pound tire 6 times in 16 seconds). He still enters ketosis at least once per week as a result of fasting (one primary meal per day at ~6 to 8 p.m.), and he feels he is at his best on a ketogenic diet. His main reason for moving away from it was a craving for more fruits and vegetables.
    Peter is obsessed with many things, including watches (like the Omega Speedmaster Professional, Caliber 321, which has been around since the 1950s) and professional-grade car racing simulators. The simulator Peter owns uses iRacing software, but the hardware (seated cockpit, steering wheel, hydraulics, etc.) is all custom-built, so it doesn’t have a name. His favorite car to drive is the Formula Renault 2000.

    WHY PETER AND I GET ALONG
    Peter explains the joy of drinking his first experimental batch of synthetic (exogenous) ketones:
    “The first one I tried was the beta-hydroxybutyrate ester, which a very good friend of mine sent me [Dominic D’Agostino, page 21], and I had been told these things taste horrible. I had talked to two people who had consumed them before, and these are stoic, military dudes. These weren’t 6-year-old kids. They said, ‘Oh, man, that’s the worst-tasting stuff on earth.’ So I knew that, but I think that piece of information was fleeting in the excitement when the box came. I tore open the box, and there was also a note in there that explained a somewhat palatable cocktail that you could mix—how you could mix this with ten other things. I just disregarded that and took out the 50-ml flask.
    “I chugged it, and I remember it was like 6:00 in the morning, because my wife was still sleeping. First of all, you drink it, and it tasted like how I imagine jet fuel or diesel would taste. If you’ve ever smelled distillate, it’s this horrible odor, and you can sort of imagine what it would taste like. This is what it tasted like, and so my first thought was, ‘Goddamn, what if I go blind? What if there’s methanol in here? What did I just do?’ And then my next thought was just, ‘Oh my god, you’re gagging. I mean, you’re really gagging. If you puke this stuff up, you’re gonna have to lick up your puke. It’s just gonna be a disaster.’ And so I’m retching and gagging and trying not to wake up the family and trying not to spew my ketone esters all over the kitchen. It took around 20 minutes for me to get out and do my bike ride, which was the whole purpose of that experiment.”
     
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    TOOLS OF THE TRADE
    Peter wears a Dexcom G5 continuous glucose monitor to track his glucose levels 24/7, which are displayed on his iPhone. His real goal, if he could wave a magic wand, is to keep his average glucose and glucose variability low. Outside of a lab, this approximates minimizing your insulin “area under the curve” (AUC). To accomplish this, Peter aims to keep his average glucose (per 24-hour period) at 84 to 88 mg/dl and his standard deviation below 15. The Dexcom displays all of this. Peter calibrates the Dexcom 2 to 3 times per day with a OneTouch Ultra 2 glucometer, which requires less blood and appears more accurate than the Precision Xtra that I use for ketone measurement.

    GLUTE MEDIUS WORKOUT
    “Modern man is weakest and most unstable in the lateral plane. Having a very strong gluteus medius, tensor fasciae latae, and vastus medialis is essential for complete knee-hip alignment and longevity of performance.”
    Peter once visited me in San Francisco and we went to the gym together. In between sets of deadlifts and various chalk-laden macho moves, I glanced over and saw Peter in a centerfold pose doing what looked like a Jane Fonda workout. Once I finished laughing, he explained that he avoided knee surgery thanks to this exercise set, taught to him by speed guru Ryan Flaherty and kinesiologist Brian Dorfman (Brian also helped him avoid shoulder surgery after a torn labrum).
    I tried his “reverse thighmaster” series and was dumbstruck by how weak my glute medius was. It was excruciating, and I felt and looked like an idiot. (See Coach Sommer’s quote, “If you want to be a stud . . .” on page 10.) For each of the following 7 moves, start with 10 to 15 reps each. Once you can do 20 reps for all 7 consecutively, consider adding weight to your ankles.
    You’ll likely feel quite smug and self-satisfied for the first few, but remember: No rest until all 7 are done and no rest in between exercises.
    For all of these—keep your big toe below your heel (think pigeon-toed) to ensure you’re targeting the right muscles, and perform this series 2 times per week.
     
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    #1—Up/Down

    Lie down on your side and use your arm to support your head. Keeping your legs straight, lift your top leg and lower it, keeping your foot internally rotated as described above. Don’t lift the foot very high. The max angle at your crotch should not exceed 30 degrees. Higher reduces the tension and defeats the purpose.
    For exercises #2–4, maintain a roughly 12-inch distance between your ankles at the bottom. Maximize tension on the glute medius and only move your leg in a horizontal plane. Ensure the ankle doesn’t dip when kicking behind you, for instance. In the first 1 or 2 workouts, aim to find the leg height that is *hardest* for you. It’s usually 12 to 18 inches from the lower ankle. Remember to keep toe below heel.

    #2—Front Kick/Swing
    Kick your top leg out to 45 degrees at the hip (as shown below). Think “cabaret.”

    #3—Back Swing
    Swing your leg back as far as possible without arching your back.

    #4—Full Front and Back Swing
    Swing your leg forward and then back (the previous two combined), with no pause at the midline.

    #5—Clockwise Circles
    Paint an 18-inch-diameter circle with your heel. Remember, at the bottom of the circle, your ankles should be roughly 12 inches apart. If you let the ankles get within inches of each other, you’re cheating.

    #6—Counterclockwise Circles
    Repeat in the other direction.

    #7—Bicycle Motion
    Pedal as if you were using a bicycle.
    Easy peasy, Japanesey? Switch sides and repeat.
     
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    PLANK CIRCLES ON SWISS BALL
    The goal of this separate exercise is to create scapular (shoulder blade) movement and rotation. Scapular mobility is one of the keys to upper-body function and longevity. The target muscles are the teres minor, infraspinatus, supraspinatus, subscapularis, and rhomboid.
    The setup is simple: Get into a plank position with your elbows propped on a Swiss ball, forearms pointing straight ahead. Don’t sag between the shoulder blades or at the lower back (keep the “hollow” and “protracted” positions described on page 19). Start with the legs wide for stability, and you can narrow the feet as you get stronger. Keeping your body in this position, use your forearms to move the ball as described below. One set consists of 10 to 15 reps of each of the following with no rest in between:
    Clockwise circles
    Counter-clockwise circles
    Forward and backward (i.e., sliding the elbows forward 6 to 12 inches and then back to your ribs)
    When you’re doing this correctly, you should feel your entire shoulder blades (scapulae) moving.
    Peter will do 3 total sets per workout, 2 times per week. He will superset these with “Wolverines” (Google it) on a cable machine. If done correctly, Wolverines target the rhomboids more than the deltoids.

    5 BLOOD TESTS PETER GENERALLY RECOMMENDS
    “Of course, the answers depend on the individual and the risks each person faces (cardiovascular disease, cancer, etc.) based on family history and genetics, but—broadly speaking—looking through the lens of preventing death, these five tests are very important.”
    APOE Genotype: “This informs my thinking on a person’s risk for Alzheimer’s disease (AD). The gene is far from causal, meaning, having it does not cause AD, but it increases risk anywhere from a bit to a lot, depending on which variant you have and how many copies you have. For what it’s worth, the apoE phenotype (i.e., the actual amount of the lipoprotein in circulation in your body) is more predictive of AD than the gene and is obviously a better marker to track, however [a test is] not yet commercially available. Stand by, though. I’m working on it.”
    LDL Particle Number via NMR (technology that can count the number of lipoproteins in the blood): “This 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 [that] the higher the number of these particles, the greater your risk of cardiovascular disease.”
    Lp(a) (“L-P-little-A”) via NMR: “The Lp(a) particle is perhaps the most atherogenic particle in the body, and while it’s included in the total of LDL particle numbers, I want to know if somebody has an elevated Lp(a) particle number, because that, in and of itself, independent of the total LDL particle number, is an enormous predictor of risk. It’s something we have to act on, but we do so indirectly. In other words, diet and drugs don’t seem to have any effect on that number, so we pull the lever harder on other things. Nearly 10% of people have inherited an elevated level of Lp(a), and it is hands down the most common risk for hereditary atherosclerosis. The bad news is that most doctors don’t screen for it; the good news is that knowing you have it can save your life, and a drug (in a class called “apo(a) antisense” drugs) to treat it directly will be around in approximately 3 or 4 years.”
    OGTT (Oral Glucose Tolerance Test): “In this test, you drink a glucose concoction and then look at insulin and glucose response at 60 minutes and 120 minutes. The 1-hour mark is where you may see the early warning signs with elevated glucose levels (or anything over 40 to 50 on insulin), which can represent hyperinsulinemia, a harbinger of metabolic problems. In fact, the 1-hour insulin response may be the most important metabolic indicator of your propensity to hyperinsulinemia and insulin resistance, even in the presence of normal ‘traditional’ markers such as HbA1C.”
    IGF-1 (Insulin-like Growth Factor-1): “This is a pretty strong driver of cancer. Diet choices (e.g., ketogenic diet, caloric restriction, intermittent fasting) can help keep IGF-1 levels low, if such a strategy is warranted.”
     

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