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Malé, Maldives
June 2022

I stared at the map, and pondered. 

It had been well over 2 years since I'd been truly international, and I wished to go somewhere new, ideally somewhere with good diving opportunities. I ended up deciding on the Maldives, a chain of islands in the Indian Ocean whose name literally translates to "necklace islands" in the language of Sinhala (1).

After speaking at two different conferences, I hopped on a plane to Malé. As per my usual custom whilst flying, I commenced a 5-day fast prior to boarding. Such a practice converts a potentially unhealthy event (eating frequent meals and snacks, processed food) into a healthful one, whereby one must simply focus on fasting, sleeping, and hydrating. I find that multiday fasts also mitigate jet lag.

Upon arriving, I took a speedboat form the airport to the semi-remote island of Rasdhoo, a veritable haven. I was met by the Drop Dive crew - Manuela, an adventurous young Swiss woman, and Hamza, a contemplative Maldivian diving pro. Later, I found out that Hamza holds the Maldives record for the deepest free-dive at 61 meters (although he has been as deep as 86 meters). I was shown to my simple abode, a plain and unassuming room in the White Coral Hotel, and fell into a fitful sleep that night whilst soothed by the sounds of Islam (namely the Isha prayer session, which is broadcast every evening throughout the entire island).

Islam also gently awoke me the next morning with the Fajar prayer session. As per custom, I initiated a brief exercise routine which incorporated high-intensity isometric (no body movement) and slow biometric (bodyweight-only) exercises. It may seem as though the expressions "high intensity" and "no movement" are mutually exclusive, but when done a certain way, isometric and biometric exercises can be demanding. I performed the routine every morning to a motivational theme from the movie Bloodsport (play it now if you like, it's on the right) (2). The exercise bout always consisted of seven 1-minute exercises, with no rest between exercises; by focusing exclusively on isometric and slow biometric exercises for 7 minutes with no rest, one can surpass the time under tension (time a muscle is under strain) achieved by much longer workout periods. A typical workout, for example, consisted of a 1-minute handstand, 1-minute L-sit, 1-minute diamond push-up, 1-minute boat-hold, 1-minute wall-sit on the left leg followed by the same on the right leg, and a 1-minute plank. 

After my workout on the first day, I wandered across a white sandy laneway in the bright sunlight to ​Alimente Cafe, the only place where one can obtain real coffee in Rasdhoo. Upon entering, the music of Bob Marley greeted me. Azeem, the chill dude behind the counter, must have thought I was not a Marley fan - within 30 seconds of entering, he changed the music to Metallica's Fade to Black, and he cranked it. He read me well.

The diving that first day was a sign of things to come - in other words, spectacular. The dive crew consisted of Manuela, Hamza, and Amir, a Canadian world traveller who was also completing his divemaster certification. There were but a handful of divers otherwise, all of whom dove for different reasons. My reason for diving is the same as it is for riding motorcycles - for the zen that accompanies both, which fosters a higher degree of awareness and mindfulness with respect to the moment.

After breaking my 5-day fast, I resumed my standard one-meal-a-day (OMAD) regimen. I was able to eat a low-carb or ketogenic meal on most nights, save one night where I went out with Manuela, Hamza, and a Spanish couple, Victor and Lydia, to a restaurant called the Bamboo Hut, where neither was possible. I ordered a salad and some kottu, a native dish consisting of diced roti, egg, meat, onions, chillies, and spices. I'm certain it knocked me out of ketosis for a bit, but the OMAD would have ensured the knockout would not have lasted for long. I prefer to stay in the ketogenic state continuously, but I'm ok with temporarily knocking myself out under extenuating circumstances.

Given the diminutive size of the diving group, we got to know each other more socially. Near the week's end, we went to the local floating "boat bar," which is anchored a kilometer or so off the coast and exists due to Rasdhoo's laws against drinking alcohol on the island itself. It was a pleasant evening. I stuck to water over alcohol, which Hamza noticed. He took me aside at one point and relayed several considered observations he had made during the week of diving. I must say, I was truly humbled by his words.
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I slept very well that night, as I did every night at Rasdhoo. I was able to maintain very high-quality sleep in that quiet, stress-free environment. Beyond the lack of sound, the alternation between bright, day-time sunlight and utter night-time darkness, virtually free of artificial lighting, enhanced the sleep experience even more. The sleep advantages inherent to an isolated island in the middle of the Indian Ocean are not to be overlooked.

​My final dive (and my 150th) was a special one. When diving, I always keep an eye out for an octopus, my favourite animal, but I rarely see one; they are too good at hiding. Yet on that last dive, Lydia spotted a shy octopus trying to camouflage itself inside a tiny enclave. Hesitantly, and ever so slowly, Hamza and I swam right up to it, admiring the shifting kaleidoscope of colours as the octopus altered from dark grey to bright red to shining white. I had never been so close to one, a novel experience in my book.

​After a week at Rasdhoo, I returned for a few days to the island of Hulhumale, near Malé, where I write these words now.

Beaches of Rasdhoo.

The White Coral Hotel.

Loading up the diving gear.

One fine day with the dive team.

Bloodsport theme, perfect for training in Asia (2).

Dinner at Bamboo Hut with Victor, Manuela, Hamza, and Lydia.

Post-dive, heading towards Alimente Cafe.

An evening on the boat bar.

Maldivian solace.

Resetting Metabolic Health

Even a brief, 2-week trip to a remote location such as the Maldives provides a person with an excellent opportunity to reset their metabolic health - that is, a chance to optimize their mitochondria function to the next level (3). Based on a combination of theory, data, and my own opinion, the following are my "top five" metabolic strategies for doing so (in order, from most to least effective):

(1) Fasting - A voluntary abstinence from food and drink that permits water, calorie-free fluids, or limited calorie-restricted meals for specific periods of time (3). Fasting decreases blood glucose, insulin, and excess growth factors yet increases ketones and antioxidants, diminishing mitochondria oxidative stress and encouraging mitochondria hormesis. It also increases mitochondria recycling and renewal processes. From everything I have read and experienced, nothing beats fasting when it comes to mitochondria restoration.

(2) Carbohydrate-restricted diets - Diets that limit the daily intake of digestible carbohydrate, which is replaced with one or more of fat, protein, or fiber (ideally, fat) (3). Low-carbohydrate diets limit carbohydrate intake to 50-100 g daily and ketogenic diets restrict carbohydrate intake to below 50 g daily, which leads to the induction of physiological ketosis. Carbohydrate-restricted diets induce similar mechanisms to fasting, but generally not to the same extent. Not as good as fasting, but the advantage of these diets is that they are still very effective and can be maintained indefinitely.

(3) Sleep - Sleep is a natually recurring state involving reduced interaction with the world. Numerous animal studies demonstrate that sleep deprivation is associated with mitchondria oxidative damage and dysfunction, which sleep can restore (4). Although evidence in humans is not as complete, it also shows sleep deprivation in humans leads to mitochondria damage and dysfunction (4). Given that sleep also necessarily induces short periods of fasting and has numerous benefits for the brain processing, immune function, and several other factors, sleep is the 3rd most essential metabolic strategy for health.

(4) Exercise and Recovery - The benefits of exercise for mitochondria function in muscles (and other organs, such as the brain) are well-recognized (5). However, I think these findings often lack context. First, it is not the exercise itself that enhances the mitochondria, but the recovery period afterwards. Exercise releases huge amounts of reactive oxygen species throughout the body, which damage mitochondria and can take days or even a couple of weeks to clear - there is ample evidence in humans that excessive exercise without adequate recovery leads to long-term health problems, particularly arrhythmias, hypertension, chronic kidney disorders, stress fractures, and reduced immune function (6). Second, there is a difference between fitness versus health - the former involves the ability to lift more or run further, but the latter is about maintaining optimized mitochondria function that confers freedom from chronic health problems for which simply being "fit" clearly does not achieve (6). Thus, for health, I favour shorter exercise bouts (focused on acute, rather than prolonged, bursts of reactive oxygen species), isometric and biometric exercises (which maximize time under tension and are easy on joints), and ample recovery periods (which provide sufficient time for mitochondria to undergo beneficial adaptations). Overall, exercise and recovery ranks as the 4th most important metabolic strategy.

(5) Stress Relief - Psychological stressors related to work demands, social interactions, or emotional concerns pervade the lives of many people to a significant extent, and this is only worsened by things like mainstream and social media. Although direct evidence in humans is scarce, a systematic review of animal studies showed psychological stress adversely affected mitochondria function in 19 of the 23 studies (7). Thus, focused periods away from the chronic stressors in one's life probably allow recovery not just from a psychological perspective, but from a mitochondrial one as well. Given its likely importance but weak evidence, stress relief ranks as the 5th most important metabolic strategy.

This list is not exhaustive and there are many other practices that may help to reset one's health such as practicing mindfulness, social interaction, curbing alcohol intake, ensuring adequate hydration, obtaining sufficient sunlight, and having novel experiences.

And, every once in a while, maybe a bit of Bloodsport training.

Solace.

References
(1 ) https://en.wikipedia.org/wiki/Maldives.
(2) https://www.youtube.com/watch?v=YUolv_29j6M.
(3) Phillips.. Metabolic strategies in healthcare: A new era. Aging Dis. (2021) 13(3):655-672. 
(4) Beaupre et al. Mitochondria’s role in sleep: Novel insights from sleep deprivation and restriction studies. World J Biol Psychiatry (2022) 23(1):1-13.
(5) Memme et al. Exercise and mitchondrial health. J Physiol. (2021) 599(3):803-817.
(6) Scheer et al. Potential long-term health problems associated with ultra-endurance running: A narrative review. (2022). 52(4):725-740.
(7) Picard and McEwen. Psychological Stress and Mitochondria: A Systematic Review. Psychosom Med (2018) 80(2): 141-153.