The Peter Attia Drive

#323 - CRISPR and the future of gene editing: scientific advances, genetic therapies, disease treatment potential, and ethical considerations | Feng Zhang, Ph.D. Oct 28, 2024

Feng Zhang, a professor of neuroscience at MIT and a pioneering figure in gene editing, joins Peter to discuss his groundbreaking work in CRISPR technology, as well as his early contributions to optogenetics. In this episode, they explore the origins of CRISPR and the revolutionary advancements that have transformed the field of gene editing. Feng delves into the practical applications of CRISPR for treating genetic diseases, the importance of delivery methods, and the current successes and challenges in targeting cells specific tissues such as those in the liver and eye. He also covers the ethical implications of gene editing, including the debate around germline modification, as well as reflections on Feng’s personal journey, the impact of mentorship, and the future potential of genetic medicine.

We discuss:

Feng’s background, experience in developing optogenetics, and his shift toward improving gene-editing technologies [2:45];
The discovery of CRISPR in bacterial DNA and the realization that these sequences could be harnessed for gene editing [10:45];
How the CRISPR system fights off viral infections and the role of the Cas9 enzyme and PAM sequence [21:00];
The limitations of earlier gene-editing technologies prior to CRISPR [28:15];
How CRISPR revolutionized the field of gene editing, potential applications, and ongoing challenges [36:45];
CRISPR’s potential in treating genetic diseases and the challenges of effective delivery [48:00];
How CRISPR is used to treat sickle cell anemia [53:15];
Gene editing with base editing, the role of AI in protein engineering, and challenges of delivery to the right cells [1:00:15];
How CRISPR is advancing scientific research by fast-tracking the development of transgenic mice [1:06:45];
Advantages of Cas13’s ability to direct CRISPR to cleave RNA and the advances and remaining challenges of delivery [1:11:00];
CRISPR-Cas9: therapeutic applications in the liver and the eye [1:19:45];
The ethical implications of gene editing, the debate around germline modification, regulation, and more [1:30:45];
Genetic engineering to enhance human traits: challenges, trade-offs, and ethical concerns [1:40:45];
Feng’s early life, the influence of the American education system, and the critical role teachers played in shaping his desire to explore gene-editing technology [1:46:00];
Feng’s optimism about the trajectory of science [1:58:15]; and
More.

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#322 - Bone health for life: building strong bones, preventing age-related loss, and reversing osteoporosis with evidence-based exercise | Belinda Beck, Ph.D. Oct 21, 2024

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Belinda Beck, founder of The Bone Clinic and a leading authority on exercise physiology and bone health, delves into the science of osteoporosis, bone density, and the lifelong importance of maintaining skeletal health. In this episode, she explains how the foundation for strong bones is established during childhood, offering valuable advice for parents on optimizing bone health for their kids. She also explores how bone remodeling occurs throughout life, driven by activity, nutrition, and hormones. Belinda highlights the power of resistance training in improving bone strength, even for those at risk of bone loss, and emphasizes the role of essential vitamins and minerals in maintaining bone health. She shares practical strategies, backed by research, for preventing fractures and combating osteoporosis.

We discuss:

Belinda’s journey into bone health research and training [2:45];
The physiology of bone and how bones adapt to mechanical loading [8:15];
Bone development from birth to adulthood, why early life is a crucial period, the functions of osteoblasts and osteoclasts, and gender differences in BMD [14:00];
How parents can optimize their children’s bone health through diet (calcium and vitamin D), sunlight exposure, and physical activity [27:30];
The best sports and activities for promoting bone health, weight training for kids, and advice for parents [36:30];
The impact of corticosteroid use on bone health in children and strategies to minimize negative effects [48:30];
Advice for people in middle age to preserve bone density: physical activity and bone-loading exercises [52:00];
Bone loss during the menopause transition for women: hormone replacement therapy and other strategies to mitigate BMD losses [59:30];
Interpreting the bone mineral density results from a DEXA scan: T-score, Z-score, and more [1:03:00];
The LIFTMOR study: testing the effects of heavy weightlifting on bone health in postmenopausal women with low bone density [1:10:15];
Profound benefits of weight training outside of BMD improvements: exploring the broader impacts on patients in the LIFTMOR study [1:19:30];
Guidance for people wanting to use exercise designed to improve their bone health [1:29:30]; and
More.

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#321 – Dopamine and addiction: navigating pleasure, pain, and the path to recovery | Anna Lembke, M.D. Oct 14, 2024

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Anna Lembke is the Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic and author of Dopamine Nation: Finding Balance in the Age of Indulgence. In this episode, Anna dives deep into the biochemistry and neurobiology of addiction, exploring the critical role of dopamine and the prefrontal cortex. She shares her framework for diagnosing and treating addiction, providing real-world examples involving alcohol, gambling, cannabis, social media, and more. Anna outlines the risk factors for addiction, including inherited and nurture-based risks, explores the rise of addictions in younger generations, and discusses effective ways to address these issues with children. Additionally, she touches on healthy coping strategies, the evolution of the “marshmallow experiment,” and provides insights into GLP-1 agonists as a possible tool for addiction treatment. Finally, she reflects on the value of 12-step programs and how she navigates the emotional challenges of her work.

We discuss:

The role of dopamine and the prefrontal cortex in addiction [3:00];
The clinical definition of addiction and the behavioral criteria for diagnosing it [13:00];
Assessing alcohol use: patterns, risks, and addiction diagnosis [17:15];
Applying the addiction diagnosis framework using gambling as an example [21:45];
Exploring addiction variability: how nature, nurture, and access shape individual vulnerability and drug of choice [25:15];
How abstinence from addictive behaviors can help reset the brain’s reward system and improve mental health [41:15];
Safely abstaining from addiction substances, drugs needing medical supervision, and other key considerations [51:30];
Transitioning from abstinence to long-term recovery: tools and considerations [59:00];
Exploring behavioral addictions like sex addiction, and the gender differences in addiction patterns [1:08:30];
Factors contributing to the increasing levels of addiction across the world [1:13:45];
How online pornography can affect young boys' developing brains and lead to addictive behaviors, and strategies for parents to address this issue [1:23:30];
The link between social media use and declines in mental health, potential solutions, and protective measures [1:34:45];
How exercise affects brain chemistry, the role of dopamine and endorphins, and how exercise can become addictive [1:44:00];
Cold-water immersion for mood regulation, and other healthy coping strategies [1:47:15];
The “marshmallow experiment”: how broken promises affect behavior and trustworthy environments help children develop self-control [1:54:00];
Can GLP-1 agonists be useful in treating addiction? [1:58:30];
The benefits of 12-step programs [2:06:00];
Why understanding a patient’s story is essential for meaningful psychiatric care [2:11:45]; and
More.

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#320 – AMA 64: New insights on GLP-1 agonists (Ozempic, Wegovy, Mounjaro) - efficacy, benefits, risks, and considerations in the rapidly evolving weight-loss drug landscape Oct 07, 2024

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In this “Ask Me Anything” (AMA) episode, Peter dives back into the increasingly popular topic of GLP-1 agonists, such as Ozempic and Mounjaro, which have garnered widespread attention for their ability to promote weight loss. Peter covers the latest findings in this rapidly evolving landscape, including new insights into their long-term efficacy, side effects, and what happens when the drug is discontinued. Peter also explores their impact on body composition and how resistance training interacts with these treatments. Additionally, he compares different GLP-1 receptor agonists and discusses promising new drugs in the pipeline. Finally, Peter addresses questions about the role of compounding pharmacies in the GLP-1 agonist market, compares oral vs. injectable options, and provides key considerations for anyone deciding whether to use a GLP-1 agonist for weight loss.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #64 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

The rapidly evolving landscape of GLP-1 agonists [2:15];
The mechanism of GLP-1 agonists, their origin as diabetes treatments, and how they evolved into weight-loss drugs [6:45];
Overview of new data and open questions related to the benefits and risks of GLP-1 agonists [10:30];
New insights into the long-term safety of GLP-1 agonists, side effects, and more [16:45];
The long-term efficacy of GLP-1 agonists, financial barriers, and more [19:45];
The mechanisms behind GLP-1 agonists' ability to promote weight loss [22:00];
New data on body weight changes after discontinuing the drug [26:00];
Effects of GLP-1 agonists on lean mass and body composition, and the role of protein and resistance training in preserving muscle [31:30];
Semaglutide vs. tirzepatide: comparing benefits and side effects [36:30];
How compounding pharmacies affect availability of GLP-1 drugs and the types of formulations that are available [39:15];
How do oral formulations of GLP-1 drugs compare to injectable formulations? [44:15];
How do sublingual (under tongue) formulations of GLP-1 drugs compare to injectable formulations? [46:15];
Guidance for using compounding pharmacies to purchase GLP-1 agonists [47:15];
Data on retatrutide—a promising new triple receptor agonist in the pipeline [50:15];
Can GLP-1 agonists be beneficial for sleep apnea and immune function? [57:00];
Potential neuroprotective benefits of GLP-1 agonists: impact on dementia risk [1:00:45];
Exploring why GLP-1 agonists may reduce the risk of cancer, kidney disease, and cardiovascular disease [1:04:00];
How GLP-1 agonists might boost fertility in women [1:10:15];
Early indications that GLP-1 agonists may help treat substance abuse disorders [1:12:00];
Potential health risks of GLP-1 agonists: addressing thyroid cancer concerns and the unknowns due to lack of data [1:14:00];
Examining the potential link between GLP-1 agonists and increased depression or suicidal ideation [1:16:00];
Major remaining questions: the effects of cyclic use, rebound appetite, impact on adolescents' development, and more [1:19:30];
Key considerations when deciding whether to use a GLP-1 agonist for weight loss [1:23:45]; and
More.

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#319 ‒ Peter's key takeaways on liver health, heart rate variability, AI in medicine, klotho, and lactate metabolism | Quarterly Podcast Summary #2 Sep 30, 2024

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In this quarterly podcast summary (QPS) episode, Peter summarizes his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from each episode, covering diverse topics such as liver health with Julia Wattacheril, heart rate variability with Joel Jamieson, artificial intelligence with Zak Kohane, klotho for brain health with Dena Dubal, and lactate and lactate metabolism with George Brooks. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these engaging discussions.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the episode #319 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Overview of topics, and the positive feedback on the quarterly podcast summary format [2:00];
Julia Wattacheril episode: liver health and disease [4:00];
Noninvasive methods to diagnose liver conditions, and how to manage and improve liver health [16:00];
Joel Jamieson episode: heart rate variability (HRV) for training and health [27:15];
Practical tools for measuring HRV and how it informs training and recovery decisions [37:00];
Zak Kohane episode: artificial intelligence and medicine [47:15];
The current role of AI in medicine and how it could revolutionize medicine in the future [53:45];
The limitations and concerns pertaining to AI [1:00:15];
Dena Dubal episode: the potential benefits of klotho for brain health [1:05:00];
Animal studies on klotho and brain health [1:11:00];
Genetics-based variations in klotho levels in humans and their impact on cognition, disease risk, and longevity [1:14:15];
Testing klotho levels, the significance of the KL-VS variant, the role of exercise in increasing klotho, and more [1:17:30];
The potential of klotho as a treatment for cognitive decline and Alzheimer's disease [1:23:15];
George Brooks episode: a new paradigm to think about lactate and lactate metabolism [1:27:45];
The potential for lactate infusions to aid in brain recovery following a head injury [1:34:00];
The relationship between lactate and cancer, and the impact of exercise on lactate levels and cancer risk [1:36:30]; and
More.

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#318 ‒ Cycling phenom and Tour de France champion Tadej Pogačar reveals his training strategies, on-bike nutrition, and future aspirations Sep 23, 2024

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Tadej Pogačar is a three-time Tour de France champion and one of the most dominant cyclists of his generation. In this episode, he shares insights into his 2020 Tour de France victory, his historic 2024 season winning both the Giro d’Italia and Tour de France, and the struggles he faced in 2022 and 2023. He also dives into his training regimen, nutrition, and the key metrics he tracks, like power, VAM, and heart rate variability. Tadej offers a glimpse into his goals for the future and what it takes to stay at the top of the sport.

We discuss:

2020 Tour de France win [4:30];
Learning from previous mistakes [8:45];
Training: simulating steep climbs and other challenging race conditions [10:30];
Tadej’s historic 2024 season and what contributed to his success [12:30];
Nutrition for optimal performance: offseason diet and carbohydrate intake during intense training sessions [15:30];
Training metrics: heart rate, power output, VAM, and HRV, and his approach to zone 2 training [18:15];
Epic climbs in the Tour de France, mindset after challenging stages, and rebuilding confidence after the 2023 Tour [25:45];
Racing dynamics, media criticism, and Tadej’s reflections on racing records [32:15];
Training in the off-season [39:00]; and
More.

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#317 ‒ Reforming medicine: uncovering blind spots, challenging the norm, and embracing innovation | Marty Makary, M.D., M.P.H. Sep 16, 2024

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Marty Makary, a Johns Hopkins surgeon and New York Times bestselling author, returns to The Drive to discuss his latest book, Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health. In this episode, Marty explores how a new generation of doctors is challenging long-held medical practices by asking critical new questions. He discusses the major problems of groupthink and cognitive dissonance in the medical community and delves into several of the "blind spots" raised in the book, including treatments for appendicitis, the peanut allergy epidemic, misunderstandings about HRT and breast cancer, antibiotic use, and the evolution of childbirth. He explains the urgent need for reform in medical education and the major barriers standing in the way of innovative medical research. Throughout the conversation, Marty offers insightful reflections on where medicine has succeeded and where there’s still room to challenge historic practices and embrace new approaches.

We discuss:

The issue of groupthink and cognitive dissonance in science and medicine [2:30];
How a non-operative treatment for appendicitis sheds light on cognitive dissonance [7:00];
How cognitive dissonance and effort justification shape beliefs and actions [13:15];
How misguided peanut allergy recommendations created an epidemic [17:45];
The enduring impact of misinformation and fear-based messaging around hormone replacement therapy allegedly causing breast cancer [25:15];
The dangers of extreme skepticism and blind faith in science, and the importance of understanding uncertainty and probability [28:00];
The overuse of antibiotics and the rise of antibiotic resistant infections and poor gut health [33:45];
The potential correlations between early antibiotic use and chronic diseases [40:45];
The historical and evolving trends in childbirth and C-section rates [50:15];
Rethinking ovarian cancer: recent data challenging decades of medical practice and leading to new preventive measures [1:05:30];
Navigating uncertainty as a physician [1:19:30];
The urgent need for reform in medical education [1:21:45];
The major barriers to innovative medical research [1:27:30];
The dogmatic culture of academic medicine: why humility and challenging established norms are key for progress [1:38:15];
The major successes and ongoing challenges of modern medicine [1:51:00]; and
More.

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#316 - AMA #63: A guide for hair loss: causes, treatments, transplants, and sex-specific considerations Sep 09, 2024

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In this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of hair loss, exploring its relationship with aging and its impact on quality of life. The conversation focuses on androgenic alopecia, the most common form of hair loss in both men and women, and covers the differences in patterns and causes between the sexes. Peter delves into the right timing for treatment, breaking down various options such as minoxidil and finasteride, low-level laser therapy, platelet-rich plasma injections, and more. Additionally, Peter outlines the pros and cons of the two primary hair transplantation methods and concludes with practical advice on selecting the right specialist or treatment team for those facing hair loss.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #63 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

The impact of hair loss on emotional health [2:15];
The prevalence, patterns, and causes of hair loss in men and women [5:15];
The genetic and hormonal causes of hair loss, and the role of dihydrotestosterone (DHT) in androgenic alopecia [8:45];
The visual differences in hair loss patterns between men and women, and the importance of consulting a specialist to rule out non-genetic causes of hair loss [13:30];
How genetic predisposition influences the risk of androgenic alopecia, and how early detection through diagnostic tools and blood tests can help manage risk more effectively [16:45];
Ideal timing for starting treatment: why early treatment is crucial for effectively managing hair loss [19:30];
The various FDA-approved treatments for androgenic alopecia, their mechanisms, and additional off-label treatments commonly used to manage hair loss [24:30];
Topical minoxidil—the most commonly recommended starting treatment for hair loss [30:15];
Oral vs. topical minoxidil: efficacy, ease of use, and potential side effects that must be considered [33:45];
Finasteride for treating hair loss: efficacy, potential side effects on libido, and the need for careful PSA monitoring in men to avoid missing early signs of prostate cancer [37:15];
Other effective hair loss treatments for women: boosting hair density with spironolactone gel and ketoconazole shampoo as part of a comprehensive strategy [41:30];
Low-level laser therapy: effectiveness, costs, practicality, and a comparison of in-office treatments with at-home devices [49:00];
Platelet-rich plasma (PRP) as a treatment for hair loss: potential effectiveness, varying protocols, and significant costs [53:45];
Hair transplant for advanced hair loss: criteria and considerations [58:00];
Types of hair transplants: follicular unit transplantation (FUT) vs. follicular unit extraction (FUE) [1:02:00];
The financial cost of hair transplant surgery, and what to consider when seeking affordable options [1:06:15];
The potential risks and downsides of the various hair transplant procedures [1:09:30];
Post-procedure care for hair transplants and whether the procedure must be repeated periodically [1:16:30];
Combining different hair loss treatments: benefits, risks, and considerations [1:18:30];
Emerging hair loss treatments with limited data [1:21:00];
Key considerations for selecting the right treatment plan for hair loss [1:22:00];
A summary of the different considerations for men and women facing hair loss [1:24:30];
Practical advice on selecting the right specialist or treatment team [1:26:15]; and
More.

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Improve your decision-making, frameworks for learning, backcasting, and more | Annie Duke (#60 rebroadcast) Sep 02, 2024

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In this episode, former World Series of Poker champion and author Annie Duke explains how poker is a pertinent model system for decision-making in the real world, a system which blends imperfect information with some unknown percentage of both luck and skill. Annie breaks down the decision-making matrix, revealing how we often focus too narrowly on just one of the four quadrants, missing out on valuable learning opportunities in the remaining 75% of situations. She delves into how our tendency to evaluate only negative outcomes leads to a culture of risk aversion. This mindset, she argues, stifles the kind of bold decision-making necessary for progress and innovation across various fields, from poker and sports to business and medicine. Annie also introduces a robust framework for learning and the levels of thought required to excel in any domain. Finally, she discusses a strategy called “backcasting”, a concept that resonated deeply with Peter in terms of how he thinks about extending healthspan.

We discuss:

Annie’s background, favorite sports teams, and Peter’s affinity for Bill Belichick [1:30];
Chess vs. poker: Which is a better metaphor for decision-making in life (and medicine)? [6:45];
Thinking probabilistically: Why we aren’t wired that way, and how you can improve it for better decision-making [12:30];
Variable reinforcement: The psychological draw of poker that keeps people playing [19:15];
The role of luck and skill in poker (and other sports), and the difference between looking at the short run vs. long run [32:15];
A brief explanation of Texas hold ‘em [41:00];
The added complexity of reading the behavior of others players in poker [47:30];
Why Annie likes to “quit fast,” and why poker is still popular despite the power of loss aversion [52:45];
Limit vs. no-limit poker, and how the game has changed with growing popularity [55:15];
The advent of analytics to poker, and why Annie would get crushed against today’s professionals [1:04:45];
The decision matrix, and the “resulting” heuristic: The simplifier we use to judge the quality of decisions —The Pete Carroll Superbowl play call example [1:10:30];
The personal and societal consequences of avoiding bad outcomes [1:21:45];
Poker as a model system for life [1:31:30];
How many leaders are making (and encouraging) status-quo decisions, and how Bill Belichick’s decision-making changed after winning two Super Bowls [1:35:15];
What did we learn about decision-making from the Y2K nothingburger? And how about the D-Day invasion? [1:39:30];
The first step to becoming a good decision maker [1:43:00];
The difference between elite poker players and the ones who make much slower progress [1:49:45];
Framework for learning a skill, the four levels of thought, and why we hate digging into our victories to see what happened [1:52:15];
The capacity for self-deception, and when it is MOST important to apply four-level thinking [2:00:30];
Soft landings: The challenge of high-level thinking where there is subtle feedback and wider skill gaps [2:11:00];
The benefits of “backcasting” (and doing pre-mortems) [2:13:30];
Parting advice from Annie for those feeling overwhelmed (and two book recommendations) [2:21:30]; and
More.

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#315 ‒ Life after near-death: a new perspective on living, dying, and the afterlife | Sebastian Junger Aug 26, 2024

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Sebastian Junger is an award-winning journalist, bestselling author, and previous guest on The Drive. In this episode, Sebastian returns to discuss his latest book, In My Time of Dying: How I Came Face to Face with the Idea of an Afterlife. This episode delves into Sebastian's profound near-death experience and how it became the catalyst for his exploration of mortality, the afterlife, and the mysteries of the universe. They discuss the secular meaning of what it means to be sacred, the intersection of physics and philosophy, and how our beliefs shape our approach to life and death. He also shares how this experience has profoundly changed him, giving him a renewed perspective on life—one filled with awe, gratitude, deeper emotional awareness, and a more engaged approach to living.

We discuss:

How Sebastian’s near-death experience shaped his thinking about mortality and gave him a reverence for life [3:00];
The aneurysm that led to Sebastian’s near-death experience [6:30];
Emergency room response, his subsequent reflections on the event, and the critical decisions made by the medical team [16:30];
Sebastian’s reaction to first learning he nearly died, and the extraordinary skill of the medical team that save his life [26:00];
Sebastian’s near-death experience [37:00];
The psychological impact of surviving against overwhelming odds [48:00];
Ignored warning signs: abdominal pain and a foreshadowing dream before the aneurysm rupture [54:30];
Sebastian's recovery, his exploration of near-death experiences, and the psychological turmoil he faced as he questioned the reality of his survival [58:15];
A transformative encounter with a nurse who encouraged Sebastian to view his near-death experience as sacred [1:03:30];
How Sebastian has changed: a journey toward emotional awareness and fully engaging with life [1:08:45];
The possibility of an afterlife, and how quantum mechanics challenges our understanding of existence [1:15:15];
Quantum paradoxes leading to philosophical questions about the nature of reality, existence after death, and whether complete knowledge could be destructive [1:26:00];
The sweet spot of uncertainty: exploring belief in God, post-death existence, and meaning in life [1:37:00];
The transformative power of experiencing life with awe and gratitude [1:53:00]; and
More.

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#314 ‒ Rethinking nutrition science: the evolving landscape of obesity treatment, GLP-1 agonists, protein, and the need for higher research standards | David Allison, Ph.D. Aug 19, 2024

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David Allison, a leading expert in obesity and nutrition, quantitative genetics, clinical trials, and research methodology, returns to The Drive to explore the evolving landscape of nutrition science and obesity treatment. In this episode, David begins by discussing the intricate relationship between nutrition, obesity, and body composition, emphasizing the multifaceted impacts of food beyond mere calorie intake. David provides a critical analysis of the complexities in nutrition research and their practical implications for tackling obesity. He critiques historical public health policies, addresses the trust issues plaguing nutrition science, and underscores the need for a paradigm shift to more effectively combat obesity. The conversation also delves into the rise of GLP-1 receptor agonists like Ozempic and Mounjaro, exploring their ethical and practical considerations in obesity treatment. The episode concludes with an in-depth look at protein intake recommendations and highlights the significant research gaps that remain in the field.

We discuss:

The complex relationship between nutrition, body weight, and body composition [2:30];
The slow progress in addressing obesity and public health despite substantial effort and investment [7:30];
The very limited success of public health initiatives in curbing obesity [17:15];
The evolving landscape of obesity research: public health initiatives and the impact of pharmacological success [26:30];
Rethinking obesity solutions: the need for a paradigm shift [32:45];
Understanding environmental triggers and embracing a balanced approach to addressing obesity that includes both pharmacological treatments and realistic lifestyle changes [41:45];
The need for higher standards in obesity research [51:45];
The rapid success of GLP-1 receptor agonists for weight loss: a discussion on the societal impact and controversy of their growing usage [1:02:15];
The ethical and practical considerations of obesity drugs: risks, benefits, and motivations for usage [1:11:30];
The use of GLP-1 agonists by athletes as performance enhancers [1:23:45];
Unanswered questions about protein intake and health [1:30:45];
Future research needed to understand basic questions around protein intake [1:45:00];
David’s weekly newsletter: “Obesity and Energetics Offerings” [1:50:45]; and
More.

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#313 - AMA #62: Protein’s impact on appetite and weight management, and uric acid's link to disease and how to manage levels Aug 12, 2024

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In this “Ask Me Anything” (AMA) episode, Peter dives into two important health topics: uric acid and protein, examining them from unique perspectives. For uric acid, he explores its metabolic role and connection to various diseases, focusing on the potential causal link with cardiovascular disease. He also discusses factors influencing uric acid levels, such as diet, genetics, and lifestyle, providing practical tips for effective management. Shifting to protein, Peter delves into its role in appetite and weight management, the consequences of insufficient protein, and the “protein leverage hypothesis” linking protein deficiency to obesity. He covers optimal protein intake and its impact on energy expenditure, and he compares the satiety effects of solid versus liquid protein. Finally, Peter shares his strategy for incorporating protein into a comprehensive weight management plan.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #62 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Overview of episode topics (and an important discussion on fanny packs) [2:00];
Understanding uric acid: its role in metabolic processes, its association with gout and kidney stones, its impact on blood pressure, and more [6:00];
Non-modifiable factors that influence uric acid levels [11:00];
Modifiable factors that influence uric acid levels [14:15];
Association between high uric acid levels and cardiovascular disease [20:00];
Evidence suggesting a causal link between high uric acid levels and cardiovascular disease [24:00];
Inconclusive evidence about the cardiovascular benefits of lowering uric acid pharmacologically [28:15];
Exploring the potential risks of low uric acid levels in neurodegenerative diseases [37:00];
Managing uric acid levels: dietary interventions and pharmacological approaches [42:00];
The impact of protein on appetite and weight management [44:00];
The consequences of insufficient protein on eating behaviors and satiety [52:15];
The relationship between protein deficiency and obesity: exploring the “protein leverage hypothesis” [57:15];
The impact of protein intake on energy expenditure [1:02:15];
Determining optimal protein intake to avoid deficiency and support health [1:05:45];
The role of different amino acids and protein sources in promoting satiety [1:08:15];
Comparing the satiety effects of solid vs. liquid protein sources [1:10:30];
Peter’s framework for incorporating protein intake into a strategy for controlling body weight [1:12:00]; and
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#312 - A masterclass in lactate: Its critical role as metabolic fuel, implications for diseases, and therapeutic potential from cancer to brain health and beyond | George A. Brooks, Ph.D. Aug 05, 2024

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George A. Brooks is a renowned professor of integrative biology at UC Berkeley. Known for his groundbreaking "lactate shuttle" theory proposed in the 1980s, George revolutionized our understanding of lactate as a crucial fuel source rather than just a byproduct of exercise. In this episode, George clarifies common misconceptions between lactate and lactic acid, delves into historical perspectives, and explains how lactate serves as a fuel for the brain and muscles. He explores the metabolic differences in exceptional athletes and how training impacts lactate flux and utilization. Furthermore, George reveals the significance of lactate in type 2 diabetes, cancer, and brain injuries, highlighting its therapeutic potential. This in-depth conversation discusses everything from the fundamentals of metabolism to the latest research on lactate's role in gene expression and therapeutic applications.

We discuss:

Our historical understanding of lactate and muscle metabolism: early misconceptions and key discoveries [3:30];
Fundamentals of metabolism: how glucose is metabolized to produce ATP and fuel our bodies [16:15];
The critical role of lactate in energy production within muscles [24:00];
Lactate as a preferred fuel during high-energy demands: impact on fat oxidation, implications for type 2 diabetes, and more [30:45];
How the infusion of lactate could aid recovery from traumatic brain injuries (TBI) [43:00];
The effects of exercise-induced lactate [49:30];
Metabolic differences between highly-trained athletes and insulin-resistant individuals [52:00];
How training enhances lactate utilization and facilitates lactate shuttling between fast-twitch and slow-twitch muscle fibers [58:45];
The growing recognition of lactate and monocarboxylate transporters (MCT) [1:06:00];
The intricate pathways of lactate metabolism: isotope tracer studies, how exceptional athletes are able to utilize more lactate, and more [1:09:00];
The role of lactate in cancer [1:23:15];
The role of lactate in the pathophysiology of various diseases, and how exercise could mitigate lactate's carcinogenic effects and support brain health [1:29:45];
George’s current research interests involving lactate [1:37:00];
Questions that remain about lactate: role in gene expression, therapeutic potential, difference between endogenous and exogenous lactate, and more [1:50:45]; and
More.

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#311 ‒ Longevity 101: a foundational guide to Peter's frameworks for longevity, and understanding CVD, cancer, neurodegenerative disease, nutrition, exercise, sleep, and more Jul 29, 2024

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In this special episode, Peter provides a comprehensive introduction to longevity, perfect for newcomers or those looking to refresh their knowledge. He lays out the foundational concepts of lifespan, healthspan, and the marginal decade. Additionally, Peter discusses the four main causes of death and their prevention, as well as detailing the five key strategies in his longevity toolkit to improve lifespan and healthspan. Detailed show notes provide links for deeper exploration of these topics, making it an ideal starting point for anyone interested in understanding and improving their longevity.

We discuss:

Key points about starting exercise as an older adult [2:45];
Overview of episode topics and structure [1:45];
How Peter defines longevity [3:45];
Why healthspan is a crucial component of longevity [11:15];
The evolution of medicine from medicine 1.0 to 2.0, and the emergence of medicine 3.0 [15:30];
Overview of atherosclerotic diseases: the 3 pathways of ASCVD, preventative measures, and the impact of metabolic health [26:00];
Cancer: genetic and environmental factors, treatment options, and the importance of early and aggressive screening [33:15];
Neurodegenerative diseases: causes, prevention, and the role of genetics and metabolic health [39:30];
The spectrum of metabolic diseases [43:15];
Why it’s never too late to start thinking about longevity [44:15];
The 5 components of the longevity toolkit [46:30];
Peter’s framework for exercise—The Centenarian Decathlon [47:45];
Peter’s nutritional framework: energy balance, protein intake, and more [58:45];
Sleep: the vital role of sleep in longevity, and how to improve sleep habits [1:08:30];
Drugs and supplements: Peter’s framework for thinking about drugs and supplements as tools for enhancing longevity [1:13:30];
Why emotional health is a key component of longevity [1:17:00];
Advice for newcomers on where to start on their longevity journey [1:19:30]; and
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#310 - The relationship between testosterone and prostate cancer, testosterone replacement therapy, and tools for predicting cancer aggressiveness and guiding therapy | Ted Schaeffer, M.D., Ph.D. Jul 22, 2024

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Ted Schaeffer is an internationally recognized urologist specializing in prostate cancer and a returning guest on The Drive. In this episode, Ted provides insights into the role testosterone plays, or doesn't play, in the initiation and progression of prostate cancer. He unpacks the findings and limitations of the recent TRAVERSE trial, exploring the complex relationship between testosterone and prostate cancer. Ted delves into the molecular nature of prostate cancer, explaining the androgen receptor saturation theory and the potential impact of testosterone on cancer growth. He also discusses the use of the Decipher test to predict cancer aggressiveness and guide targeted treatment. Furthermore, Ted shares how he counsels patients regarding testosterone replacement therapy (TRT), including its safe administration in patients with low-grade prostate cancer. Additionally, he highlights advancements in prostate cancer therapies and biomarkers that help develop precise treatment strategies while minimizing the need for broad androgen deprivation therapy.

We discuss:

Background on the TRAVERSE trial: insights into exogenous testosterone and prostate cancer risk [3:00];
The androgen receptor saturation theory: how different organs respond to varying levels of testosterone [10:30];
The relationship between testosterone levels and prostate cancer aggressiveness: how aggressive prostate tumors have lower androgen receptor activity and rely on different growth mechanisms [16:15];
Using the Decipher score to assess prostate cancer aggressiveness and guide personalized treatment strategies [23:45];
Considerations for testosterone replacement therapy: how Ted counsels patients, how TRT can be safely administered in patients with low-grade prostate cancer, and more [31:15];
Advancements in prostate cancer therapies and PSA as a biomarker for precise treatment decisions, minimizing the need for broad androgen deprivation therapy [38:30]; and
More.

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#309 ‒ AI in medicine: its potential to revolutionize disease prediction, diagnosis, and outcomes, causes for concern in medicine and beyond, and more | Isaac Kohane, M.D., Ph.D. Jul 15, 2024

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Isaac "Zak" Kohane, a pioneering physician-scientist and chair of the Department of Biomedical Informatics at Harvard Medical School, has authored numerous papers and influential books on artificial intelligence (AI), including The AI Revolution in Medicine: GPT-4 and Beyond. In this episode, Zak explores the evolution of AI, from its early iterations to the current third generation, illuminating how it is transforming medicine today and unlocking astonishing possibilities for the future. He shares insights from his unconventional journey and early interactions with GPT-4, highlighting significant AI advancements in image-based medical specialties, early disease diagnosis, and the potential for autonomous robotic surgery. He also delves into the ethical concerns and regulatory challenges of AI, its potential to augment clinicians, and the broader implications of AI achieving human-like creativity and expertise.

We discuss:

Zak’s unconventional journey to becoming a pioneering physician-scientist, and his early interactions with GPT-4 [2:15];
The evolution of AI from the earliest versions to today’s neural networks, and the shifting definitions of intelligence over time [8:00];
How vast data sets, advanced neural networks, and powerful GPU technology have driven AI from its early limitations to achieving remarkable successes in medicine and other fields [19:00];
An AI breakthrough in medicine: the ability to accurately recognize retinopathy [29:00];
Third generation AI: how improvements in natural language processing significantly advanced AI capabilities [32:00];
AI concerns and regulation: misuse by individuals, military applications, displacement of jobs, and potential existential concerns [37:30];
How AI is enhancing image-based medical specialties like radiology [49:15];
The use of AI by patients and doctors [55:45];
The potential for AI to augment clinicians and address physician shortages [1:02:45];
The potential for AI to revolutionize early diagnosis and prediction of diseases: Alzheimer’s disease, CVD, autism, and more [1:08:00];
The future of AI in healthcare: integration of patient data, improved diagnostics, and the challenges of data accessibility and regulatory compliance [1:17:00];
The future of autonomous robotic surgery [1:25:00];
AI and the future of mental health care [1:31:30];
How AI may transform and disrupt the medical industry: new business models and potential resistance from established medical institutions [1:34:45];
Potential positive and negative impacts of AI outside of medicine over the next decade [1:38:30];
The implications of AI achieving a level of creativity and expertise comparable to exceptional human talents [1:42:00];
Digital immortality and legacy: the potential to emulate an individual's personality and responses and the ethical questions surrounding it [1:45:45];
Parting thoughts [1:50:15]; and
More.

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Zone 2 training: impact on longevity and mitochondrial function, how to dose frequency and duration, and more | Iñigo San-Millán, Ph.D. (#201 rebroadcast) Jul 08, 2024

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Iñigo San-Millán is an internationally renowned applied physiologist and a previous guest on The Drive. His research and clinical work focuses on exercise-related metabolism, metabolic health, diabetes, cancer metabolism, nutrition, sports performance, and critical care. In this episode, Iñigo describes how his work with Tour de France winner Tadej Pogačar has provided insights into the amazing potential of elite athletes from a performance and metabolic perspective. He speaks specifically about lactate levels, fat oxidation, how carbohydrates in food can affect our lactate and how equal lactate outputs between an athlete and a metabolically unhealthy individual can mean different things. Next, he discusses how Zone 2 training boosts mitochondrial function and impacts longevity. He explains the different metrics for assessing one’s Zone 2 threshold and describes the optimal dose, frequency, duration, and type of exercise for Zone 2. Additionally, he offers his thoughts on how to incorporate high intensity training (Zone 5) to optimize health, as well as the potential of metformin and NAD to boost mitochondrial health. Finally, he discusses insights he’s gathered from studying the mitochondria of long COVID patients in the ICU.

We discuss:

The amazing potential of cyclist Tadej Pogačar [2:00];
Metrics for assessing athletic performance in cyclists and how that impacts race strategy [7:30];
The impact of performance-enhancing drugs and the potential for transparency into athletes’ data during competition [16:15];
Tadej Pogačar’s race strategy and mindset at the Tour de France [23:15];
Defining Zone 2, fat oxidation, and how they are measured [26:00];
Using fat and carbohydrate utilization to calculate the mitochondrial function and metabolic flexibility [35:00];
Lactate levels and fat oxidation as it relates to Zone 2 exercise [39:15];
How moderately active individuals should train to improve metabolic function and maximize mitochondrial performance [51:00];
Bioenergetics of the cell and what is different in elite athletes [56:30];
How the level of carbohydrate in the diet and ketogenic diets affects fuel utilization and power output during exercise [1:07:45];
Glutamine as a source for making glycogen—insights from studying the altered metabolism of ICU patients [1:14:15];
How exercise mobilizes glucose transporters—an important factor in diabetic patients [1:20:15];
Metrics for finding Zone 2 threshold—lactate, heart rate, and more [1:24:00];
Optimal Zone 2 training: dose, frequency, duration, and type of exercise [1:40:30];
How to incorporate high intensity training (Zone 5) to increase VO2 max and optimize fitness [1:50:30];
Compounding benefits of Zone 2 exercise and how we can improve metabolic health into old age [2:01:00];
The effects of metformin, NAD, and supplements on mitochondrial function [2:04:30];
The role of lactate and exercise in cancer [2:12:45];
How assessing metabolic parameters in long COVID patients provides insights into this disease [2:18:30];
The advantages of using cellular surrogates of metabolism instead of VO2 max for prescribing exercise [2:25:00];
Metabolomics reveals how cellular metabolism is altered in sedentary individuals [2:33:00];
Cellular changes in the metabolism of people with diabetes and metabolic syndrome [2:38:30]; and
More.

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#308 - AMA #61: Sun exposure, sunscreen, and skin health: relationship between sun exposure and skin cancer, vitamin D production, and photoaging, how to choose a sunscreen, and more Jul 01, 2024

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In this “Ask Me Anything” (AMA) episode, Peter delves into two topics that have generated a lot of questions over the years: skin cancer and sunscreen. He begins by exploring the basics of UV radiation, discussing its effects on vitamin D conversion, photoaging, and its role in skin cancer. He examines various skin types, discussing their implications for sun exposure and vitamin D levels, as well as how to determine where you fall on the skin type scale. He then delves into the various types of skin cancer, with a particular emphasis on melanoma, exploring its complex relationship with UV exposure and other contributing risk factors. Additionally, he covers tanning beds, the importance of early skin cancer detection through regular skin checks, and the often confusing topic of sunscreen. He explains how sunscreen affects UV radiation and skin cancer risk, what SPF levels to choose, the differences between organic and mineral sunscreens, and what to consider when selecting the best sunscreen for your needs.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #61 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

The impact of UV radiation on the skin [2:00];
Understanding solar UV: from the electromagnetic spectrum to skin health [3:45];
The role of sunlight in vitamin D production [8:30];
Factors contributing to vitamin D deficiency: insufficient UV exposure, magnesium levels, and more [9:45];
Sun exposure needs for different skin types, and the limitations of current studies in defining vitamin D deficiency [12:45];
The acute and long-term effects of excessive UV exposure: sunburn, photoaging, and the increased risk of skin cancer [15:30];
Types of skin cancer and associations with UV exposure [17:45];
The complex relationship between melanoma and UV exposure [22:15];
Why UV exposure alone doesn’t necessarily explain the risk for melanoma [25:15];
Other risk factors for melanoma [29:15];
Tanning beds and skin cancer risk [34:45];
Balancing sun exposure: benefits and risks [38:15];
Tattoos and sun exposure [40:30];
The importance of regular skin checks, dermatologists, and emerging technologies showing promise for early detection of cancer [41:45];
Self-skin checks: what to look for [46:30];
Prevalence of skin cancer and the importance of early detection [49:30];
Summary of the major risk factors for melanoma [54:15];
The role of sunscreen in reducing skin cancer risk [55:45];
How sunscreen works, the differences between chemical and mineral sunscreens, an explanation of SPF, and more [58:30];
How to determine the appropriate sunscreen SPF to use based on the UV index [1:04:45];
Choosing the right sunscreen for your individual needs [1:07:00];
The impact of water and perspiration on sunscreen effectiveness [1:12:00];
Chemical vs. mineral sunscreens: safety concerns and recommendations [1:14:00];
Concerns about hormone effects from chemical sunscreens [1:19:15];
Sunscreen summary: skin types, key considerations, recommended brands, and more [1:23:15]; and
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#307 ‒ Exercise for aging people: where to begin, and how to minimize risk while maximizing potential | Peter Attia, M.D. Jun 24, 2024

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In this special episode, Peter addresses the common questions about starting or returning to an exercise routine over the age of 50. Individuals in this age group have frequently reached out with questions about whether it's too late to start exercising and often express concern over a lack of prior training, a fear of injury, or uncertainty about where to begin. Peter delves into the importance of fitness for older adults, examining all four pillars of exercise, and provides practical advice on how to start exercising safely, minimize injury risk, and maximize potential benefits. Although this conversation focuses on people in the “older” age category, it also applies to anyone of any age who is deconditioned and looking to ease into regular exercise.

We discuss:

Key points about starting exercise as an older adult [2:45];
Why it’s never too late to begin exercising and incorporating the four pillars of exercise [5:45];
The gradual, then sharp, decline in muscle mass and activity level that occur with age [10:00];
The decline of VO2 max that occurs with age [15:30];
Starting a training program: exercise variability, movement quality, realistic goals, and more [18:30];
Improving aerobic capacity: the malleability of the system, the importance of consistency, and setting long-term fitness goals [25:15];
Starting cardio training: base building, starting with low volume, and zone 2 training [30:45];
The critical role of VO2 max in longevity [36:45];
How to introduce VO2 max training to older or deconditioned individuals [46:15];
Options for performing zone 2 and VO2 max training [53:45];
The ability to make gains in strength and muscle mass as we age [57:00];
How to implement strength training for older individuals [1:01:00];
Advice for avoiding injury when strength training [1:07:30];
Risk of falls: the devastating consequences and the factors that increase fall risk [1:12:15];
Mitigating fall risk: the importance of foot and lower leg strength, ankle mobility, and balance [1:19:45];
Improving bone mineral density through resistance training [1:24:30];
The importance of protein in stimulating muscle protein synthesis, especially in older adults [1:31:00];
Parting advice from Peter [1:34:00]; and
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#306 - AMA #60: preventing cognitive decline, nutrition myths, lowering blood glucose, apoB, and blood pressure, and more Jun 17, 2024

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In this “Ask Me Anything” (AMA) episode, Peter provides insights on a broad range of important topics. He delves into the prevention of cognitive decline, the link between cardiovascular disease and Alzheimer's disease, and methods to lower blood glucose, insulin, and apoB. He also addresses nutrition-related queries, exploring the impact of dietary habits on weight loss and longevity, how a person can identify the best diet for themselves, and common nutrition myths. Additional discussions include optimal blood pressure, daily step goals, the benefits of standing versus sitting desks, and much more.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #60 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Overview of topics and episode format [1:40];
Preventing cognitive decline [5:00];
How to lower blood glucose and insulin [13:30];
The relationship between lipids, CVD, and Alzheimer’s disease, and whether statins can increase the risk of neurodegenerative disorders and AD [23:15];
Reducing apoB levels through exercise and diet [31:45];
Pharmacological options for lowering apoB [38:00];
How nutrition impacts longevity via metabolic health, muscle mass, BMD and more [40:15];
How can someone determine the best diet for themselves? [43:45];
Nutrition myth: All weight loss is good [46:45];
Nutrition myth: Metabolic rates are dramatically different among individuals based on genetics [49:00];
Nutrition myth: Losing weight after a brief period of overeating is impossible [53:45];
Nutrition myth: GLP-1 agonists are a replacement for a healthy lifestyle [57:45];
Nutrition myth: There is a single best diet for weight loss [1:03:00];
Nutrition oversimplification: All calories are created equal [1:05:45];
Daily step goals [1:06:45];
The benefits of standing versus sitting throughout the day [1:10:45];
How to identify the most impactful and easiest-to-implement ways to improve your health [1:12:30];
The critical importance of emotional health [1:14:30];
Why supplements should be considered as supportive aids rather than primary solutions in one’s strategy to improve longevity [1:18:00];
Strategies for reducing high blood pressure [1:20:45];
Peter’s biggest frustrations with "mainstream health advice" [1:28:00];
Peter’s chaotic, yet cherished, morning routine [1:31:00]; and
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#305 ‒ Heart rate variability: how to measure, interpret, and utilize HRV for training and health optimization | Joel Jamieson Jun 10, 2024

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Joel Jamieson is a conditioning expert who developed Morpheus to give people a smarter way to build their conditioning regimen and improve their recovery. In this episode, Joel dives deep into the world of heart rate variability (HRV), explaining its scientific foundation, how it measures the balance between the sympathetic and parasympathetic nervous systems, the various methods of measurement, and how it can guide healthier lifestyle choices and improved training performance. He explores the nuances of HRV calculation, the impact of aging on HRV, and the roles of genetics, exercise, and other lifestyle factors in this process. He also covers Morpheus, the innovative training tool that won Peter over after his initial skepticism, highlighting its practicality and effectiveness in guiding training and optimizing fitness outcomes.

We discuss:

Heart rate variability (HRV): evolution, science, and practical applications of HRV in athletic training [4:00];
Methods of measuring HRV: EKG, wrist-based sensors, and more [11:30];
How HRV is calculated from the data [22:30];
The role of the autonomic nervous system (ANS) in regulating HRV [25:45];
The decline in HRV with age, and the mitigating effects of fitness and other lifestyle factors [33:30];
The role of genetics in HRV, the modifiability of HRV, and a comparison of VO2 max and HRV as predictors of mortality [37:00];
How aging affects HRV and sympathetic drive, and the importance of spontaneous movement and exercise in maintaining the body's adaptability [43:30];
How Morpheus measures HRV using RMSSD and normalizes it to a 100-point scale for easier interpretation [49:45];
The Morpheus system: development, integration with various metrics, and personalized daily training recommendations to optimize fitness and recovery [51:30];
The benefits of morning HRV readings for assessing daily readiness compared to overnight HRV measurements [1:03:00];
Why Morpheus recommends using a chest strap rather than an arm band [1:10:00];
The impact of consistent exercise, stress, alcohol, and other lifestyle factors on HRV [1:11:15];
Optimizing zone 2 training with Morpheus [1:18:15];
Using heart rate recovery (HRR) as an indicator of athletic conditioning and the balance between aerobic and anaerobic systems [1:22:45];
The importance of tracking HRV trends over time rather than focusing on data from a given day [1:29:00];
Effect of GLP-1 agonists on heart rate and HRV [1:34:45];
Where HRV belongs in the hierarchy of health metrics [1:42:00];
Parting thoughts [1:46:30]; and
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#304 – NEW: Introducing quarterly podcast summaries - Peter shares his biggest takeaways on muscle protein synthesis, VO2 max, toe strength, gut health, and more Jun 03, 2024

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In this quarterly podcast summary (QPS) episode, Peter introduces a new format aimed at summarizing his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from each episode, covering diverse topics such as protein and muscle building with Luc van Loon, toe strength with Courtney Conley, VO2 max with Olav Aleksander Bu, liquid biopsies for cancer with Alex Aravanis, gut health and probiotics with Colleen Cutcliffe, and road safety with Mark Rosekind. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these engaging discussions.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the episode #304 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

How Peter keeps track of his takeaways from each podcast episode [5:15];
Luc van Loon episode: fat utilization, muscle protein synthesis, dietary protein, aging and inactivity, and more [8:45];
Behavioral changes that have come about from the conversation with Luc van Loon [23:45];
Courtney Conley episode: importance of toe strength and the impact of dedicated foot training [26:45];
Olav Aleksander Bu episode: the importance of VO2 max for lifespan, and the practicalities of measuring and improving VO2 max [36:45];
Behavioral changes that have come about from the conversation with Olav [56:00];
Alex Aravanis episode: liquid biopsies for cancer detection [1:01:30];
Colleen Cutcliffe episode: the importance of gut bacteria balance, and the potential therapeutic uses of probiotics, particularly Akkermansia [1:16:45];
Mark Rosekind: the significant issue of road fatalities and injuries, their causes, and practical safety measures to reduce risks [1:27:00]; and
More.

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#303 - A breakthrough in Alzheimer’s disease: the promising potential of klotho for brain health, cognitive decline, and as a therapeutic tool for Alzheimer's disease | Dena Dubal, M.D., Ph.D. May 27, 2024

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Dena Dubal is a physician-scientist and professor of neurology at UCSF whose work focuses on mechanisms of longevity and brain resilience. In this episode, Dena delves into the intricacies of the longevity factor klotho: its formation and distribution in the body, the factors such as stress and exercise that impact its levels, and its profound impact on cognitive function and overall brain health. Dena shares insights from exciting research in animal models showing the potential of klotho in treating neurodegenerative diseases as well as its broader implications for organ health and disease prevention. She concludes with an optimistic outlook for future research in humans and the potential of klotho for the prevention and treatment of Alzheimer’s disease.

Disclosure: Peter is an investor in Jocasta Neuroscience, a company working to develop klotho as a therapy for people with Alzheimer’s disease.

We discuss:

Dena’s fascination with aging and how she came to study klotho [3:30];
Biological properties of klotho: production, regulation, decline with age, and factors influencing its levels [11:45];
Potential benefits of klotho on brain health [22:00];
The relationship between soluble klotho protein, platelet factors, and cognitive enhancement [33:45];
The role of platelet factor 4 (PF4) and it’s interaction with GluN2B in mediating cognitive enhancement [46:45];
Benefits of klotho observed in a mouse model of Parkinson’s disease [55:45];
Benefits of klotho observed in a mouse model of Alzheimer’s disease [1:03:00];
Promising results of klotho in primate models, and the importance of finding an appropriate therapeutic dose before moving to human trials [1:08:00];
Speculating why a single klotho injection has such long-lasting effects [1:25:30];
Potential cognitive benefits of klotho in humans, the impact of the KL-VS genetic variant on klotho levels, and the need for human trials to confirm these effects [1:27:45];
The interaction between the KL-VS genetic variant and APOE4 and how it impacts risk of Alzheimer’s disease [1:34:45];
The significance of klotho levels: studies linking lower levels to increased mortality and the broader implications for organ health and disease prevention [1:47:15];
Measuring klotho levels and determining an individual’s KL-VS status [1:52:15];
The promising potential of klotho for Alzheimer’s disease treatment, and the importance of philanthropy for funding research [1:58:00]; and
More.

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#302 - Confronting a metabolic epidemic: understanding liver health and how to prevent, diagnose, and manage liver disease | Julia Wattacheril, M.D., M.P.H. May 20, 2024

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Julia Wattacheril is a physician scientist and director of the Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) program at Columbia University Irving Medical Center. In this episode, Julia delves deep into the complex world of liver health, beginning with a foundational overview of liver physiology. She provides an in-depth look at how alcohol impacts liver function, breaking down the metabolism of ethanol and its detrimental effects. Julia then shifts the focus to understanding liver function tests and optimal enzyme levels, providing a detailed explanation of AST and ALT and elucidating why fluctuations in these levels may or may not be concerning. She provides a primer on the four major stages of liver disease, discussing risk and emphasizing the importance of early diagnosis. Julia highlights the role of liver disease in increasing the risk of cancer and cardiovascular disease and covers in detail the various strategies for diagnosing, treating, and preventing the progression of liver disease.

We discuss:

Julia’s training, the importance of liver health, and the challenges and innovations of hepatology [3:15];
The complex and crucial functionality of the liver, its four most essential functions, and more [8:45];
Liver injuries: historical and evolving understanding of causal factors, and the progression to liver diseases and cancer [13:15];
How the liver metabolizes nutrients and what happens in the presence of excess calories or alcohol [24:45];
Methods of diagnosing liver disease and how insights guide treatment and management strategies [33:30];
The poisonous nature of ethanol to the liver [40:30];
Varied responses to alcohol, damaging effects of alcohol beyond the liver, and the process of advising patients on their alcohol consumption [47:15];
Understanding liver enzymes AST and ALT—interpreting levels, lifestyle factors that affect them, and diagnostic approaches [58:30];
Interpreting liver function tests for fatty liver disease, and the challenges of diagnosing liver pathologies, particularly in children versus adults [1:13:15];
Comprehensive liver health assessments via imaging and various diagnostic tools to prevent overlooking potential liver pathologies [1:18:45];
Potential impact of recreational drugs, statins, and other medications on liver function test results [1:26:45];
Shifting nomenclature from NAFLD to MASLD to reflect accuracy in the underlying pathophysiology and understanding of liver diseases [1:30:30];
Pathophysiology of MASLD, the need for proactive screening, and the significance of liver fat percentage as an indicator of metabolic health [1:36:30];
The importance of screening for rare conditions alongside common metabolic diseases associated with fatty liver accumulation [1:42:45];
Practical strategies for managing MAFLD [1:45:30];
The impact of fructose consumption on liver health and the challenges of disentangling its effects from other factors like obesity and insulin resistance [1:52:45];
The potential of GLP-1 agonists for the treatment of MASLD [1:57:45];
How the four stages of liver disease have evolved [2:00:30];
Increased cancer and heart disease risk associated with early-stage MAFLD [2:05:15];
Emerging drugs and therapies for addressing fat accumulation and fibrosis related to MAFLD [2:12:15];
Peter’s major takeaways [2:18:45]; and
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#301 - AMA #59: Inflammation: its impact on aging and disease risk, and how to identify, prevent, and reduce it May 13, 2024

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In this “Ask Me Anything” (AMA) episode, Peter delves into the often misunderstood concept of inflammation. He first defines inflammation and differentiates between acute inflammation and chronic inflammation, the latter of which is linked to aging and a plethora of age-related diseases. Peter breaks down the intricate relationship between chronic inflammation, obesity, and metabolic health, and highlights the signs that might suggest someone may be suffering from chronic inflammation. From there, the conversation centers on actionable advice and practical steps one can take to manage and minimize chronic inflammation. He explores how diet plays a crucial role, including the potential benefits of elimination diets, and he examines the impact of lifestyle factors such as exercise, sleep, and stress management. Additionally, he discusses the relevance of food inflammatory tests and concludes by examining the potential benefits and drawbacks of drugs and supplements in managing inflammation.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #59 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Defining inflammation (and the cultural impact of Napoleon Dynamite) [1:45];
Acute vs chronic inflammation [8:00];
The connection between chronic inflammation, aging, and age-related diseases [11:00];
The impact of inflammation on metabolic health [18:30];
Understanding and diagnosing chronic inflammation: blood tests and other approaches, and challenges with measurement [20:00];
Factors that contribute to low-level chronic inflammation [28:00];
Minimizing inflammation through diet [29:45];
The important role of fiber for gut health and inflammation [33:45];
A closer look at the impact of trans fats and saturated fats on overall health [34:45];
Why Peter prefers dietary fiber from food sources over supplements [38:30];
Debunking “superfoods”: emphasizing proven methods over marketing claims for reducing inflammation [39:00];
Is there any value in over-the-counter food inflammatory tests? [42:30];
Food elimination diets: how they work, symptoms and markers to watch, challenges and limitations [45:15];
Identifying dietary triggers for gut-related symptoms through low-FODMAP diets like the “carnivore diet” [51:15];
Dairy: the complex role of dairy on inflammation and individual responses [55:00];
Wheat: the complexities and conflicting evidence around wheat's inflammatory effects [57:45];
How exercise influences inflammation [1:02:00];
How sleep quality and duration impacts inflammation [1:07:00];
The potential impact of chronic psychological stressors on inflammation [1:13:00];
The impact of oral health on inflammation and overall well-being [1:15:00];
The role of medications in managing chronic inflammation [1:18:15];
Supplements: evaluating the efficacy of various anti-inflammatory supplements [1:22:15];
Parting thoughts and takeaways [1:27:00]; and
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#300 - Special episode: Peter on exercise, fasting, nutrition, stem cells, geroprotective drugs, and more — promising interventions or just noise? May 06, 2024

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In this special edition celebrating 300 episodes of The Drive, Peter discusses a variety of popular topics and health interventions and classifies them based on their level of evidence and relevance using the following categories: proven, promising, fuzzy, noise, and nonsense. Peter first delves into the topic of geroprotective molecules, covering rapamycin, metformin, NAD and its precursors, and resveratrol. Next, he explores the significance of metrics like VO2 max and muscle mass, as well as emerging concepts like blood flow restriction and stem cells. The conversation extends to nutrition, addressing questions surrounding long-term fasting, sugar consumption, sugar substitutes, and the contentious role of red meat in cancer. Peter not only provides his current stance on each topic—most of which have been covered in great detail in the previous 300 episodes—but also reflects on how his opinion may have evolved over the years.

We discuss:

Defining the categories of “proven, promising, fuzzy, noise, and nonsense” [3:15];
Rapamycin [9:30];
Metformin [17:00];
NAD and its precursors [24:30];
Resveratrol [32:45];
The importance of VO2 max, muscle mass, and muscular strength for lifespan [38:15];
Blood flow restriction (BFR) training [44:00];
Using stem cells to treat osteoarthritis or injury [51:30];
Fasting as a tool for longevity (and why Peter stopped his fasting protocol) [55:45];
The energy balance theory [1:06:30];
The idea that sugar is poison [1:12:00];
The idea that sugar substitutes are dangerous [1:22:15];
The debate on red meat and cancer [1:28:45]; and
More.

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Special episode with Dax Shepard: F1 and the 30th anniversary of Ayrton Senna’s death Apr 29, 2024

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This is a special episode of The Drive with Peter’s friend and fellow car enthusiast Dax Shepard. In this podcast, which commemorates the 30th anniversary of the death of Brazilian Formula One legend Ayrton Senna, Dax sits down with Peter to better understand what made Senna so special and why Peter remains an enormous fan. This conversation focuses on Senna’s life, the circumstances of his death, and his lasting impact and legacy on the sport of F1.

We discuss:

Peter’s interest in motorsports began as a child [2:30];
The drama and dangers of F1 [6:00];
What made Senna special [13:00];
What Senna meant to Brazilians [24:00];
The cause of the fatal crash [28:15];
Why Peter is obsessed with Senna [40:30];
Being the best versus having the best record [43:30];
Senna’s unique driving style and incredible intuition about automotive engineering [46:30];
Back to the day of the dreadful race [53:00];
What Peter believes caused the crash [1:02:45];
Views on dying young, in the prime of life [1:13:00];
Senna lives on in his foundation and in safety changes adopted by F1 [1:21:00];
Statistics aren’t enough for fandom, and why people like who they do [1:24:15];
The biggest difference between F1 today and F1 in the 80s [1:28:30];
Senna’s driving superpower [1:30:30];
The fastest drivers currently in F1 [1:38:30];
Current F1 obsessions [1:45:00];
How hard it is to do what the top F1 drivers do [1:50:15];
Dax’s love of motorcycles and his AMG E63 station wagon [1:52:15];
Awesome Senna mementos from Etsy [2:01:15];
What makes specialists interesting, and Max’s devotion to F1 [2:10:15];
What Senna might have done if he had not died that day [2:14:00];
Michael Schumacher and Max Verstappen are also top F1 drivers [2:17:30];
Interlagos in Sao Paulo Brazil is always an incredible experience [2:18:45]; and
More.

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#299 ‒ Optimizing muscle protein synthesis: the crucial impact of protein quality and quantity, and the key role of resistance training | Luc van Loon, Ph.D. Apr 22, 2024

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Luc van Loon is an internationally renowned expert in skeletal muscle metabolism. In this episode, Luc starts with an exploration of the roles of insulin and triglycerides in endurance exercise, highlighting their impact on skeletal muscle metabolism, and he offers profound insights into the significance of protein in this context. He elucidates how different protein types and forms influence muscle protein synthesis rates, exploring the nuances of protein absorption, digestibility, amino acid quality, and their implications for performance and recovery. Delving deeper, he differentiates between animal and plant protein sources, unraveling the distinctive properties of various protein types, from the differences between whey and casein to the emerging trends in collagen protein supplementation. Moreover, Luc dissects the intricate connections among physical activity, lean muscle mass, muscle protein synthesis induced by resistance training, and dietary protein.

We discuss:

Luc’s background and insights about fuel selection during exercise [3:30];
Fuel utilization during endurance exercise [9:30];
Fat metabolism, intramuscular lipids, and the nutritional dynamics of endurance sports [17:15];
The optimal window for replenishing intramuscular fat stores and glycogen post-exercise [25:15];
Luc’s interest in protein metabolism and exploration of amino acids' dual role as building blocks and signaling molecules in driving muscle protein synthesis [32:15];
How protein metabolism differs between sedentary individuals and those engaged in predominantly strength training or endurance training [38:45];
The basics of how proteins are digested and absorbed, and how muscle protein synthesis is measured [50:30];
How factors like food texture, cooking methods, and protein composition impact muscle protein synthesis, and the importance of protein distribution throughout the day [59:45];
Differences in whey and casein proteins, and the ability of ingested protein to stimulate muscle protein synthesis [1:03:30];
Dietary protein distribution and quantity for the maximization of muscle protein synthesis [1:09:00];
Muscle loss with age and inactivity and the importance of resistance exercise to maintain type II muscle fibers [1:17:15];
Differences between whey and casein proteins, and the importance of both quantity and quality of protein sources [1:28:30];
Optimizing muscle protein synthesis: exercise, timing of protein intake, protein quality, and more [1:37:00];
How to preserve muscle while trying to lose weight [1:46:00];
Anabolic resistance and overcoming it with physical activity [1:55:45];
Importance of protein intake and physical activity in hospitalized patients [2:06:30];
Reviewing the efficacy of collagen supplements [2:13:30];
Plant-based diets: how to ensure a balance of amino acids, and other considerations [2:20:30];
Future research: understanding protein metabolism in the brain [2:23:45]; and
More.

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#298 ‒ The impact of emotional health on longevity, self-audit strategies, improving well-being, and more | Paul Conti, M.D. Apr 15, 2024

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Paul Conti is an author and practicing psychiatrist who specializes in helping people heal from trauma. In this episode, Paul returns to The Drive to delve into the intricate relationship between emotional health, healthspan, and lifespan. He first challenges common assumptions about the inevitable decline of emotional health with age, providing strategies for conducting a comprehensive audit of internal emotional health. He establishes a framework for the foundation of good emotional health: a balance between the generative drive, the assertive drive, and the pleasure drive. Paul also explores the nuanced dynamics of motivation, happiness, and satisfaction as it relates to material possessions, draws connections between physical and emotional well-being, confronts the impact of negative self-talk, and describes how making peace with our mortality can foster a sense of hope, purpose and well-being. Additionally, Paul offers many practical insights into initiating emotional health improvements and navigating the search for a suitable therapist.

We discuss:

The importance of prioritizing emotional health as we age [2:45];
The impact of emotional health on healthspan and how to foster a proactive approach to emotional well-being [7:00];
The discrepancy between outward success and inner fulfillment, and the importance of a healthy “generative drive” for genuine well-being [13:00];
A deeper dive into generative drive: impact on human behavior, resilience, purpose, and more [23:15];
Evaluating one’s inner self: introspection, self-awareness, challenging societal norms, and returning to the basics of physical and emotional well-being [29:00];
Self-auditing tools: introspection, curiosity, and exploring underlying reasons for unwanted behaviors [41:45];
Breaking free from destructive cycles by understanding the continuum of self-care and addictive behaviors and remaining curious [50:15];
Critical self talk: the malleability of one’s inner dialogue and the potential for transformative change with perseverance and self-compassion [1:00:15];
Slowing the anger response and gaining insights into the underlying triggers to achieve lasting change and self-understanding [1:13:45];
Foster gratitude and humility by achieving balance between the three drives—assertion, pleasure, and generative [1:20:45];
The conflict between intellectual understanding and emotional feelings, problematic comparison frameworks, and the importance of living in the present with intentionality [1:24:15];
How making peace with our mortality can foster a sense of hope, purpose and well-being [1:34:45];
Advice for finding a compatible therapist [1:43:45];
The key components of therapeutic progress [1:57:00];
The caricatures of four common patient phenotypes, and how to get through to them [2:05:30];
How Paul manages his own well-being and the emotional challenges that come with his line of work [2:15:15]; and
More.

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#297 - AMA #58: Iron: its role in health, testing methods, and strategies for preventing and managing iron deficiency Apr 08, 2024

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In this “Ask Me Anything” (AMA) episode, Peter delves into the crucial yet often overlooked topic of iron and iron deficiency. He explores why iron is indispensable for the body, explains the repercussions of iron deficiency, and sheds light on the prevalence of this issue and who is most susceptible. Peter outlines strategies for increasing iron levels, covering dietary iron, supplementation, and infusion options, while also discussing the suitability of each approach for different individuals. Shifting gears, Peter tackles rapid-fire questions on creatine and sodium, as well as inquiries related to his book.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #58 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Overview of today’s topics and the importance of understanding iron levels in the body [1:45];
The importance and ubiquity of iron in the body, and the role of the protein called ferritin [4:30];
The processes of iron absorption, utilization, and transportation [9:30];
Options for testing iron levels and how to interpret the results [13:45];
What does it mean to be iron deficient, and how is it different from anemia? [17:15];
Symptoms of iron deficiency and/or anemia [22:15];
How prevalent is iron deficiency, and who is most susceptible? [24:30];
The importance of consuming an adequate amount of iron daily to prevent deficiency [30:30];
The best way to improve iron levels for someone who is deficient [34:45];
Iron supplementation: various formulations and potential side effects [37:45];
Intravenous iron infusion as an alternative to oral supplements -- plus restless legs syndrome and other topics [42:00];
Iron supplementation: who should and should not consider it [44:00];
Peter’s approach to creatine and his pre- and post-workout supplements [50:15];
Navigating sodium intake: effect on blood pressure, who should use precaution, and other considerations [54:45];
Peter’s thoughts about the potential of writing another book [57:15]; and
More.

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#296 ‒ Foot health: preventing and treating common injuries, enhancing strength and mobility, picking footwear, and more | Courtney Conley, D.C. Apr 01, 2024

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Courtney Conley is an internationally renowned foot and gait specialist. In this episode, Courtney delves into the intricate world of foot anatomy and functionality. She explores the complexities of the foot, discussing its anatomy, common injuries, and the importance of understanding its structure in preventing issues. She covers a range of foot ailments, factors contributing to them, treatment options, and prevention strategies. She delves into the significance of loading, balance, range of motion, and posture, emphasizing the crucial role of strength in preventing both injuries and falls. Additionally, she sheds light on the interconnectedness of the kinetic chain, from the leg muscles down to the foot, and how issues within this chain can cascade downstream, leading to various injuries and pathologies. Additionally, she provides a comprehensive overview of footwear, discussing suitable options for both adults and children to promote foot health and mitigate potential problems.

In addition to this interview, Courtney also recorded a series of videos to better explain a number of the concepts discussed such as diagnostic tests that are used to determine mobility and strength and the exercises one should perform to improve the outcomes based on the diagnostics. The interview will be available to everyone while the videos from the gym will only be available to paid subscribers (found at the end of the show notes page).

We discuss:

Why Courtney chose to specialize in the foot [3:30];
The vital role of foot strength, function, and health in human movement and well-being [6:15];
Anatomy of the rear foot and midfoot [10:15];
The development of flat feet, the impact of footwear, and the benefits of going barefoot [19:45];
Anatomy of the forefoot, common injuries, and why most injuries occur in the forefoot [23:15];
Foot musculature and its role in maintaining foot stability and preventing deformities like bunions and hammer toes [30:15];
The intrinsic musculature of the foot, plantar fasciitis, footwear, and more [39:00];
Plantar fasciitis: diagnosis, causes, and treatment [51:30];
Posterior leg muscles: strength assessment methods, role in ACL injuries, and more [59:15];
Lateral and medial muscles: ankle stability, arch support, big toe stabilization, and exercises to strengthen and prevent injuries [1:04:15];
Importance of strength of lower leg muscles for gait and preventing shin splints, stress injuries, and more [1:08:15];
Tendinopathies and other common pathologies related to the anterior and lateral compartments of the foot [1:13:00];
The importance of midfoot integrity, ankle dorsiflexion, and a discussion of gait alterations [1:19:45];
Proximal stability and its implications for posture and movement patterns [1:27:00];
The age-related decline in foot sensation and strength [1:32:45];
Common toe injuries, treatment, and how to prevent further progression of the injury [1:36:30];
Preventing falls and managing arthritis with proactive foot care and exercises [1:46:45];
Footwear: advice for picking shoes that promote foot health [1:54:45];
Footwear for runners [2:05:30];
The importance of prioritizing footwear that promotes natural foot movement and strength while considering individual comfort and foot health needs [2:09:30]; and
More.

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#295 ‒ Roadway death and injury: why everyone should care and what you can do to reduce risk | Mark Rosekind, Ph.D. Mar 25, 2024

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Mark Rosekind is an expert on road safety and a policy leader with more than 30 years of experience enacting strategic, practical, and effective data-based solutions that enhance driver and pedestrian safety and health in complex environments. In this episode, Mark delves into the persistent issue of accidental deaths resulting from roadway accidents, a concern for those focused on longevity given its consistent risk throughout life. From exploring statistics on car crashes to identifying the demographics most at risk and the key locations of incidents, he uncovers various risk factors including distractions like smartphone usage, the influence of alcohol and cannabis, the dangers of sleep deprivation, and speeding. Mark also provides practical advice for both drivers and pedestrians to enhance safety, while delving into the potential and challenges of emerging technologies such as autonomous vehicles. Additionally, Mark provides valuable resources for listeners, particularly parents navigating the road safety landscape with teenage drivers.

We discuss:

Mark’s background and education, and the profound impact of transportation accidents on human lives [4:15];
From sleep science to safety leadership: Mark’s journey in transportation innovation [14:15];
Stats on transportation accidents and fatalities [18:00];
Historical trends in road fatalities and the key contributors—impairment, distraction, and more [28:00];
The demographics of drivers involved in crashes, and the life-saving potential of better driver education programs [34:30];
The most critical areas where drivers need to be hyper-aware to protect themselves [41:00];
The role of the National Transportation Safety Board (NTSB) in accident investigations, and the importance of data sources like event data recorders (EDRs) in accident reconstruction and investigations [47:00];
The dangers of phone use while driving [53:45];
How drunk driving was addressed through advocacy and legal changes [1:01:30];
The need to address distracted driving and the psychological impact of distracted driving accidents on both victims and perpetrators[1:07:15];
Navigating the roads and lowering your risk of accidents: weather, human error, and defensive driving [1:15:45];
The impact of impaired driving: alcohol, cannabis, prescription drugs, and more [1:26:15];
Mitigating the effects of vehicle speed [1:38:15];
The promise and challenges of autonomous vehicles for road safety [1:44:15];
Automatic emergency braking (AEB): the effectiveness and challenges of implementing AEB as a standard feature in new vehicles [1:53:00];
Sleep deprivation: the impact of poor sleep, drowsiness, and disrupted circadian rhythm on driving [1:58:15];
Protecting pedestrians: strategies for reducing the risk of fatal accidents with pedestrians on foot or bicycle [2:02:30];
Empowering safe driving: essential resources and tips for parents and teenage drivers [2:14:00];
Promoting a culture of proactive safety: parting thoughts from Mark [2:19:15]; and
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#294 ‒ Peak athletic performance: How to measure it and how to train for it from the coach of the most elite athletes on earth | Olav Aleksander Bu Mar 18, 2024

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Olav Aleksander Bu is an internationally renowned sports scientist acclaimed for his coaching prowess with elite athletes spanning a diverse range of sports disciplines. In this episode, Olav delves deep into the intricacies of VO2 max and its profound impact on performance. They explore the relationship between VO2 max and ATP production, energy efficiency, and power, as well as the impact of low-intensity training on VO2 max. The conversation extends to Olav’s experiences pushing the boundaries with high-performance athletes and the data driven interventions he uses to improve performance. They also dissect the role of lactate threshold, discuss other important metrics to track, and explore the exciting possibility of utilizing a portable VO2 testing device as a practical alternative to traditional lab-based assessments.

We discuss:

Olav’s background, expertise in exercise physiology, coaching experience, and interest in the extremes of human capability [4:15];
The processes of energy conversion within the human body and its implications for performance [9:30];
Improving movement efficiency, and the importance of mindfulness in training to optimize performance [20:00];
The relationship between VO2 max, power output, and endurance performance in different sporting contexts [34:45];
How VO2 max is measured in the lab, and why it’s a crucial predictor of both lifespan and quality of life [44:45];
Absolute vs relative VO2 max, the significance of functional threshold power in cycling, and the importance of longer duration tests for accurate assessments [54:00];
Portable VO2 testing devices as a practical alternative to lab-based tests [1:05:15];
The complexities of measuring ventilation and its impact on performance metrics like VO2 max and heart rate [1:15:45];
Training interventions to increase VO2 max, and factors that impact performance outcomes [1:23:30];
The respiratory exchange ratio (RER) and endurance sports, and how factors such as diet composition and exercise intensity influence RER values and performance [1:32:45];
Science-guided training for versatile athletes: maximizing VO2 max, power, torque, and cadence in cycling, and the importance of incorporating diverse stimuli to enhance performance [1:41:00];
Physiological limitations on VO2 max [2:02:15];
The different energy systems used during work, and other things to monitor like VCO2 and heart rate [2:06:00];
Lactate threshold and other metrics to guide your training [2:10:30];
Analysis of a lactate power curve: exploring lactate dynamics in endurance training and performance [2:23:15]; and
More.

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#293 - AMA #57: High-intensity interval training: benefits, risks, protocols, and impact on longevity Mar 11, 2024

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In this “Ask Me Anything” (AMA) episode, Peter delves into the topic of high-intensity interval training (HIIT), starting with addressing some common misunderstandings around this type of exercise and breaking down what HIIT truly entails. He examines the correlation between HIIT and VO2 max, a vital metric for overall health and longevity, and describes the beneficial impact of HIIT on longevity when incorporated properly. Additionally, he emphasizes the importance of building a wide base of cardiovascular fitness, reveals the optimal protocols for incorporating HIIT into a balanced routine, and discusses the risk of injury and other potential drawbacks of HIIT.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #57 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Common questions about high-intensity interval training (HIIT) [1:30];
The origins of HIIT [3:15];
Defining HIIT training and differentiating it from sprint interval training (SIT) [5:45];
Why HIIT is often touted as a more efficient way to exercise [14:00];
Navigating the nuances of HIIT research: understanding limitations and the importance of a blended exercise routine [20:30];
The four pillars of exercise [24:15];
Using HIIT to improve VO2 max [26:00];
HIIT training for the untrained individual: impact on VO2 max and the interplay between exercise-induced adaptations and potential weight loss [33:00];
Sprint interval training (SIT) vs. HIIT: comparing the relative improvements in VO2 max and the impact of longer duration intervals [40:00];
Benefits and limitations of HIIT, drawbacks of overtraining with HIIT, and the importance of a diversified routine to increase total cardiorespiratory capacity [44:15];
HIIT protocols Peter recommends [58:45];
The risk of injury and other potential drawbacks of HIIT [1:02:15];
The importance of incorporating a balance of continuous moderate-intensity cardio and HIIT when aiming for longevity [1:04:00]; and
More.

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#292 ‒ Rucking: benefits, gear, FAQs, and the journey from Special Forces to founding GORUCK | Jason McCarthy Mar 04, 2024

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Jason McCarthy is a former US Special Forces member and the founder of GORUCK, a company specializing in rucking equipment. In this episode, Jason recounts his journey from military service to navigating the challenging transition back into civilian life and ultimately embracing the mission of introducing rucking to the masses. Delving into the significance of rucking in military training and its applicability to the wider population, he discusses the mental and physical benefits of rucking as a mode of training, provides practical tips for beginners, and answers frequently asked questions about packs, weights, footwear, and more.

We discuss:

Jason’s upbringing and what inspired him to join the military [3:15];
Jason’s path to becoming a Green Beret, his calling to serve, and staying true to oneself [10:30];
About the Green Berets: their role in the military, unique abilities, missions, and more [20:00];
The mental and physical challenges of special forces training and selection [25:00];
Rucking challenges as a Green Beret [37:00];
How Jason trained in his off-time and stayed mentally prepared [46:30];
Jason’s difficult decision to leave the army, and the challenges many veterans face returning to civilian life [51:30];
Jason’s struggles after leaving the army: loss of identity, feelings of shame, and the how he overcame a period of despair [57:15];
The origin of GORUCK [1:10:30];
The GORUCK Challenge [1:24:30];
The company's evolution from event organizer to manufacturing specialist, spurred by the growing interest in rucking as a form of training [1:35:30];
FAQs about rucking: packs, weight, rucksack vs. weighted vest, chest straps, and more [1:38:45];
Commemorating Normandy: GORUCK's plans for the 80th anniversary of the Normandy landings [1:51:30];
Footwear for rucking, and how GORUCK got into the footwear business [1:57:30];
How to avoid the most common injuries from rucking, and the benefits of rucking for VO2 max, strength, and sleep quality [2:05:00];
Advice for using rucking as a mode of training, and the advantages of rucking over other forms of training [2:12:45]; and
More.

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#291 ‒ The role of testosterone in males and females, performance-enhancing drugs, sustainable fat loss, supplements, and more | Derek, More Plates More Dates Pt.2 Feb 26, 2024

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Derek is a fitness educator, the entrepreneur behind More Plates More Dates, and an expert in exogenous molecules commonly used and misused by bodybuilders and athletes. In this episode, Derek returns to the podcast to explore the impact of exogenous molecules on male and female health. He covers testosterone, DHT, DHEA, progesterone, clomiphene (Clomid), hCG, and various peptides, alongside updates from the FDA affecting peptide use. Additionally, he addresses the recent hype around increasing muscle mass through myostatin inhibition via follistatin gene therapy and supplementation. Additionally, Derek discusses the various strategies that bodybuilders use for losing fat while preserving muscle, including insights on weight loss drugs.

We discuss:

Testosterone and DHT: mechanisms of action, regulation of muscle growth, and influence on male and female characteristics [2:15];
TRT in women: the complexities and potential risks associated with testosterone use in women [9:00];
DHEA supplementation: exploring the benefits and risks for women, and the differing effects on men vs. women [22:00];
The role of progesterone in both men and women, pros and cons of supplementation, the importance of tailored doses, and more [28:00];
Measuring levels of free testosterone [37:15];
The trend towards earlier interest in TRT, and the risks of underground sources of testosterone [42:00];
The complexities and considerations surrounding the use of Clomid, E-Clomid, and hCG in TRT [46:00];
Low testosterone: diagnosis, potential causes, treatment options, and other considerations [53:45];
Growth hormone-releasing peptides: rationale and implications of the recent FDA categorization as high-risk substances [1:03:45];
Follistatin gene therapy and myostatin inhibition for increasing muscle mass: the recent hype online, human and animal data, and the need for more research [1:14:45];
Simple tips for lowering calorie intake and losing fat [1:32:30];
Methods of sustainable fat loss with muscle preservation: insights gleaned from bodybuilders [1:40:00];
Could prolonged fasting impact testosterone levels? [1:55:30];
High-protein ice cream [1:57:00];
Exploring fat loss supplements and drugs: L-carnitine, yohimbine, and more [2:02:15];
Potential remedies for individuals experiencing metabolic dysfunction due to hypercortisolemia [2:12:30];
The cornerstones of body composition improvement remain nutrition and exercise, even in the presence of exogenous testosterone [2:19:15];
The importance of approaching health advice found online with a critical eye and a healthy dose of skepticism [2:23:30]; and
More.

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#290 ‒ Liquid biopsies for early cancer detection, the role of epigenetics in aging, and the future of aging research | Alex Aravanis, M.D., Ph.D. Feb 19, 2024

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Alex Aravanis is a leader in research and development of technologies and clinical tests utilizing the latest tools in DNA analysis and data science. In this episode, Alex delves into two interconnected topics: liquid biopsies and epigenetics. He begins by tracing the trajectory of genome sequencing and tumor sequencing, setting the stage for a detailed exploration of liquid biopsies as an early cancer detection method. The discussion encompasses key concepts such as cell-free DNA, DNA methylation, sensitivity, specificity, and the predictive values associated with liquid biopsies. Transitioning to epigenetics, Alex examines the intricate interplay of DNA methylation and aging biology and explores the possibility of using cellular reprogramming to reverse epigenetic changes that occur with aging.

We discuss:

Alex’s background in applying engineering to problems in medicine [3:15];
A primer on human genetics, and the history and current landscape of DNA sequencing [11:00];
The advent and evolution of liquid biopsies for early detection of cancer [23:15];
The role of cell-free DNA in cancer detection: how incidental findings in non-invasive prenatal testing led to the development of liquid biopsies [40:15];
The development of a universal blood test for cancer detection and a discussion of specificity of tests [46:00];
Advancements in cell-free DNA analysis and development of a multi-cancer screening test at GRAIL [51:00];
DNA methylation explained [58:15];
Optimizing cancer detection with methylation analysis of cfDNA in small blood samples [1:02:45];
The importance of understanding sensitivity, specificity, positive predictive value, and negative predictive value in cancer screening [1:08:00];
The performance of the GRAIL Galleri test and its ability to detect various types and stages of cancer [1:21:00];
Do early cancer detection methods, like liquid biopsies, translate to improvement in overall survival? [1:27:45];
The role of epigenetics in aging [1:39:30];
How cell-free DNA methylation patterns can help identify a cancer’s tissue of origin [1:45:30];
Cellular and epigenetic reprogramming and other exciting work in the field of aging [1:52:30]; and
More.

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#289 - AMA #56: Cancer screening: pros and cons, screening options, interpreting results, and more Feb 12, 2024

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In this “Ask Me Anything” (AMA) episode, the conversation focuses on cancer screening, a topic often shrouded in confusion yet crucial to understand given that early identification of a cancer is an essential part of survival strategy. Peter examines the arguments both for and against cancer screening, including addressing why some trials may show no benefit to screening. He then delves into the various screening modalities available for different cancers, highlights the pros and cons associated with each, and explains how to interpret the results. Additionally, Peter provides guidance for navigating outside of the relatively narrow and confined screening guidelines for various types of screening tests.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #56 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Why understanding cancer screening is crucial [2:45];
The prevalence of cancer diagnosis and mortality rates [4:30];
Why cancer screening and early detection is such an important part of the strategy to survive a cancer diagnosis [11:00];
Data on how cancer screening impacts survivability of cancer [16:30];
Inconsistencies between cancer screening trials regarding benefits to survival rates [25:45];
What are some of the reasons why clinical trials don’t always improve cancer-specific mortality? [30:15];
What are the arguments against population-level cancer screening? [42:00];
Cancer screening outside the recommended guidelines: risks and benefits, interpreting results, and other considerations [46:00];
Understanding sensitivity and specificity when reviewing screening results [52:30];
Risks and complications associated with colonoscopies [55:45];
Cancer screening modalities: options for cancer screening both within standard recommendations and beyond [58:30];
The strengths and limitations of various types of cancer screening [1:02:15];
Understanding positive and negative predictive value using sensitivity, specificity, and pretest probability [1:11:45];
Factors that influence an individual's pretest probability of cancer [1:13:45];
How to interpret cancer screening results [1:18:15];
The importance of having an advocate when considering out-of-guideline cancer screening tests [1:23:30];
How stacking multiple cancer screening modalities can decrease the risk of false positives [1:29:30];
Advice and guidance for making decisions related to cancer screening [1:31:15]; and
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#288 ‒ The impact of gratitude, serving others, embracing mortality, and living intentionally | Walter Green Feb 05, 2024

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Walter Green is a remarkable philanthropist, mentor, author of This Is the Moment!, and founder of the impactful “Say It Now” movement. In this episode, Walter delves into the unique insights gained from his challenging upbringing, discusses embracing mortality, and highlights the mindset of “finishing strong.” He shares insights on intentionality, thinking in reverse, saying “no,” prioritizing relationships, and the essence of focusing on others. The conversation focuses on the “Say It Now” movement, which stresses the importance of expressing sentiments to loved ones well before the end of life.

We discuss:

How Peter and Walter met through Ric Elias [2:45];
The unique perspectives and life lessons provided by Walter’s challenging childhood [5:30];
Walter’s harrowing experience with a sudden mental breakdown and his subsequent recovery with the help of therapy [11:15];
A diverse professional journey ending in great success [18:15];
The birth of a movement: celebrating friendships through public tributes and expressing gratitude to those who have shaped your life’s journey [22:30];
Intentionality, thinking in reverse, saying “no”, and other guiding principles for Walter [30:00];
Walter’s global journey of gratitude on his 70th birthday: visiting friends and creating memorable experiences [39:15];
The profound impact of acknowledging and expressing gratitude for the people who contribute to our lives [46:15];
The key elements for creating meaningful connections and cultivating deep, authentic friendships [52:15];
The “Say It Now” movement: the inspiration behind the remarkably impactful initiative [58:30];
What “finishing strong” means to Walter [1:07:30];
Finding peace at the end of life through expressing gratitude and finding purpose in serving others [1:16:00];
Resources to learn about “Say It Now” [1:26:15]; and
More.

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#287 ‒ Lower back pain: causes, treatment, and prevention of lower back injuries and pain | Stuart McGill, Ph.D. Jan 29, 2024

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Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro Inc. where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling case studies of the successful treatment of complex cases of lower back pain, reinforcing his conviction that nobody needs to suffer endlessly. He also covers the importance of strength and stability, shares his favorite exercises to prescribe to patients, and provides invaluable advice for maintaining a healthy spine.

We discuss:

Peter’s experience with debilitating back pain [3:30];
Anatomy of the back: spine, discs, facet joints, and common pain points [14:45];
Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more [24:45];
Why the majority of back injuries happen around the L4, L5, and S1 joints [31:00];
How the spine responds to forces like bending and loading, and how it adapts do different athletic activities [36:15];
The pathology of bulging discs [43:15];
The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more [46:00];
The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types [56:15];
The significance of strength and stability in preventing injuries and preserving longevity [1:08:15];
Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns [1:19:30];
Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain [1:30:00];
Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro [1:39:00];
When surgical interventions may be appropriate, and “virtual surgery” as an alternative [1:46:45];
Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more [1:55:30];
Tarlov cysts: treatment and surgical considerations [2:00:15];
The evolution of patient assessments and the limitations of MRI [2:02:15];
Pain relief related to stiffness and muscle bulk through training [2:07:00];
Advice for the young person on how to keep a healthy spine [2:14:15];
Resources for individuals dealing with lower back pain [2:25:30]; and
More.

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#286 ‒ Journal club with Andrew Huberman: the impact of light exposure on mental health and an immunotherapy breakthrough for cancer treatment Jan 22, 2024

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Andrew Huberman, professor of neurobiology at Stanford University and host of the Huberman Lab podcast, returns for another special journal club episode. Andrew introduces an observational study investigating the influence of light exposure on circadian clock regulation and its link to mental health, while Peter covers a phase III clinical trial employing immune checkpoint inhibitors for the treatment of metastatic cancer. They delve into the essential findings of their respective papers, elucidate the reasons for their enthusiasm, and tackle potential limitations and unanswered questions. Additionally, they provide valuable insights into their approaches for comprehending research studies, aiding listeners in independently navigating this process.

We discuss:

The intricate relationship between light exposure, circadian rhythms, and mental health [3:30];
The importance of low solar angle sunlight, and other types of light needed for optimal mental and physical health [12:00];
Promising new lightbulb technology that simulates low solar angle sunlight [17:45];
The significance of both darkness and the need for direct light exposure to the eyes, specifically [20:00];
Some tips and advice regarding optimizing light exposure, blue blockers, and effects on circadian rhythm [22:15];
Andrew presents a paper which suggests avoiding light at night and seeking light during the day is associated with better mental health [25:45];
Examining the data: the negative impact of increasing nighttime light exposure and the positive effects of daytime light exposure [34:30];
Statistical analysis: the importance of focusing not only on statistical significance but also clinical relevance, power analysis, error bar range, and more [45:45];
Takeaways from the study of daytime and nighttime light exposure [49:45];
The practicalities of minimizing light exposure and screen time at night, the use of sleep trackers, and overall challenge of modern, indoor lifestyles [55:15];
Potential limitations of the light exposure study, reverse causality, and the complex interplay of variables in epidemiological studies [1:06:00];
A tangent on diet soda and sugar substitutes as an example of reverse causality [1:13:15];
Andrew and Peter’s take on the causality vs. correlation of light exposure to mental health, the damage of circadian disruption, and the interpretation of observational data [1:17:30];
A primer on the immune system as background for the paper Peter chose [1:25:00];
Background on cancer: causes, how it evades the immune system, and the logic behind immune checkpoint inhibitor therapy [1:35:45];
Peter presents a paper on immune checkpoint inhibitor therapy in cancer patients [1:50:15];
Unpacking the results of the checkpoint inhibitor trial [1:59:45];
Other noteworthy observations, including the differing results between males and females [2:15:30];
Adverse effects resulting from treatment with an immune checkpoint inhibitor targeting CTLA-4 [2:20:00];
Why melanoma is especially responsive to immunotherapy, and the remarkable success story of immunotherapy for pancreatic cancer [2:25:15];
Why immunotherapy may be the most important hope we have for treating cancer [2:35:30];
Avoiding melanoma: the sunscreen debate, sunburn as the biggest risk factor, and more [2:38:45]; and
More.

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#285 - AMA #55: Exercise: longevity-focused training, goal setting, improving deficiencies, managing emotional stress, and more Jan 15, 2024

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In this “Ask Me Anything” (AMA) episode, Peter delves into the crucial topic of exercise, starting with the importance of having a goal in training, including how and why Peter uses the goal of training for the “Centenarian Decathlon” when structuring his training plans. Peter elaborates on how to identify deficient areas within the four pillars of exercise and guides listeners on incorporating periodization training for optimal improvement and training variety. The episode explores diverse case studies, offering insights into tailored workouts for individuals of various training backgrounds, from seasoned enthusiasts to complete beginners. Additionally, Peter tackles the universal issue of emotional stress and its impact on training, as well as how exercise can help manage stress and how to determine when training should be adjusted during a high-stress period.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #55 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Overview of exercise topics [2:15];
Importance of training with a goal in mind, the Centenarian Decathlon, and the natural decline of fitness with age [4:00];
The four pillars of exercise [12:15];
Measuring peak aerobic output with VO2max, and the importance of VO2max as a predictor of longevity [16:45];
Measuring aerobic efficiency with zone 2 [25:45];
Measuring and tracking muscle mass and strength [27:30];
Case study of a fit person with a neglected pillar: why adding more training volume may not the best strategy [30:30];
Periodization training: what it is and why it is beneficial [36:15];
Periodization case study: high cardio fitness, lacking muscle and strength [40:00];
Periodization case study: adequate muscle, low cardio fitness [44:45];
Case study: significant improvement needed across all exercise pillars [48:45];
Best ways to do zone 2 exercise and how to use relative perceived exertion (RPE) to find your zone 2 level [56:30];
How the body responds to physical and emotional stress, its impact on training, and the consequences of chronic stress [1:01:00];
The difference between “good” stress and “bad” or chronic stress [1:10:30];
The complex relationship between exercise and stress, and the importance of adjusting exercise goals during high-stress periods [1:13:30];
Clues that stress may be impacting your training [1:19:15];
The use of wearables and devices for tracking trends and making decisions related to training [1:21:00];
Parting thoughts regarding the importance of exercise for longevity and stress management [1:32:00]; and
More.

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#284 ‒ Overcoming addictive behaviors, elevating wellbeing, thriving in an era of excess, and the scarcity loop | Michael Easter, M.A. Jan 08, 2024

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Bestselling author Michael Easter returns to The Drive to discuss his new book, Scarcity Brain. In this episode, Michael explores the evolutionary backdrop that molded human beings, a setting characterized by scarce food, limited information, and few possessions. He contrasts that with the modern era, marked by abundance and comfort, and the ensuing repercussions on our physical and mental well-being. Michael introduces the concept of the “scarcity loop,” a three-part behavior cycle which helps explain modern challenges such as overeating, addiction, gambling, and materialism, and offers practical strategies to break free from its cycle. The episode culminates in a thought-provoking exploration of happiness, drawing on Michael's experiences with monks and underscoring the value of boredom, exploration, and discomfort as transformative elements that elevate awareness, presence, and the will to live.

We discuss:

Inspiration for Michael’s latest book, Scarcity Brain [2:15];
Evolutionary adaptations to the scarcity of food contrasted with the modern obesity crisis [4:00];
Lessons learned about diet and nutrition from living with hunter-gatherers [9:30];
The impact of ultra-processed foods on energy balance [20:30];
Michael’s experience with attempting the hunter-gatherer diet at home [27:30];
The roots of excess: factors that contribute to overeating and the varied vulnerabilities among individuals [34:00];
The scarcity loop: how components of the scarcity loop are illustrated in gambling and addiction [39:45];
Using knowledge of the scarcity loop to break the cycle [50:45];
The evolutionary drive to acquire material possessions [58:15];
The benefits of boredom and value of exploration [1:07:00];
The consequences of an attention economy driven by negativity bias [1:16:30];
Navigating the world of endless information and the value in “slow information” [1:23:00];
Defining happiness, and the downward trend in reports of happiness [1:33:00];
Purpose, austerity, self-reliance and other missing elements of happiness gleaned from the study of monks [1:38:30];
The value in uncomfortable activities that increase your awareness, presence, and will to live [1:48:45]; and
More.

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James Clear: Building & Changing Habits (#183 rebroadcast) Jan 01, 2024

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James Clear is the author of the New York Times bestseller Atomic Habits. His extensive research into human behavior has helped him identify key components of habit formation and develop the “Four Laws of Behavioral Change.” In this episode, James provides insights into how both good and bad habits are formed, including the influence of genetics, environment, social circles, and more. He points to changes one can make to cultivate more perseverance and discipline and describes the profound impact habits can have when tying them into one’s self-identity. Finally, James breaks down his “Four Laws of Behavioral Change” and how to use them to create new habits, undo bad habits, and make meaningful changes in one’s life.

We discuss:

Why James became deeply interested in habits [2:00];
Viewing habits through an evolutionary lens [6:15];
The power of immediate feedback for behavior change, and why we tend to repeat bad habits [9:30];
The role of genetics and innate predispositions in determining one’s work ethic and success in a given discipline [14:45];
How finding one’s passion can cultivate perseverance and discipline [23:30];
Advantages of creating systems and not just setting goals [29:30];
The power of habits combined with self-identity to induce change [36:45];
How a big environmental change or life event can bring on radical behavioral change [50:45];
The influence of one’s social environment on their habits [54:30];
How and why habits are formed [1:00:45];
How to make or break a habit with the “Four Laws of Behavior Change” [1:09:45];
Practical tips for successful behavioral change—the best strategies when starting out [1:16:30];
Self-forgiveness and getting back on track immediately after slipping up [1:30:45];
Law #1: Make it obvious—Strategies for identifying and creating cues to make and break habits [1:40:00];
Law #2: Make it attractive—examples of ways to make a new behavior more attractive [1:48:00];
Law #3: Make it easy—the 2-minute rule [1:59:00];
Law #4: Make it satisfying—rewards and reinforcement [2:03:45];
Advice for helping others to make behavioral changes [2:06:15]; and
More.

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#283 ‒ Gut health & the microbiome: improving and maintaining the microbiome, probiotics, prebiotics, innovative treatments, and more | Colleen Cutcliffe, Ph.D. Dec 18, 2023

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Colleen Cutcliffe is an expert in molecular biology and co-founder of Pendulum Therapeutics, a company working to develop treatments for a variety of diseases by targeting the microbiome. In this episode, Colleen delves into the complexity of the microbiome, how it is tested, and how it changes over time. She explores how probiotics, prebiotics, and postbiotics affect the gut and makes a compelling case that well-developed products have the potential not only to enhance gut health but also to positively influence overall metabolic well-being. Colleen emphasizes the significance of a high-fiber diet in sustaining a thriving gut microbiome, shares insights on minimizing microbiome damage during antibiotic use, provides tips for fostering and preserving a healthy gut, and much more.

We discuss:

Colleen’s background and current focus [4:45];
The basics of the microbiome [7:15];
The study of the human microbiome [15:15];
Categories of bacteria, and the implications on health of the rapid evolution of bacteria [19:45];
Methods for measuring and understanding the microbiome, and key indicators of microbiome health [28:30];
The important role of fiber for promoting gut health through the production of butyrate [38:30];
The case for manipulating gut bacteria via fecal microbiota transplant (FMT) [45:00];
Dynamics of the microbiome: the gut-brain connection and how antibiotics, nutrition, stress, and more impact the microbiome's diversity and function [50:15];
Factors that influence the vaginal microbiome [55:15];
The effect of gut microbes on obesity and challenges with fecal transplants in people [58:45];
Beneficial strains of gut bacteria and strains commonly found in probiotics [1:01:15];
The difference between a probiotic and prebiotic, and how CFUs are a measure of the “active ingredient” [1:09:45];
Considerations about how probiotic strains are produced, and more on the meaning of CFU [1:14:15];
Mitigating the effect of antibiotics on the microbiome [1:22:30];
What do we know about the effect of artificial sweeteners on the gut microbiome? [1:30:00];
Why Akkermansia is a keystone strain with implications for metabolic health and an individual’s response to dietary interventions [1:36:15];
The essential steps necessary to develop a robust probiotic for optimal health support [1:45:45];
How Akkermansia helps control blood glucose, and potential implications of Akkermansia in weight loss, diabetes management, and more [1:48:45];
Pendulum Therapeutics’ commitment to rigorous product develop [2:06:30];
Details about the probiotic “Glucose Control” and other probiotics developed by Pendulum Therapeutics [2:13:00];
Further studies of Akkermansia that have been proposed or are underway [2:20:30]; and
More.

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#282 - AMA #54: Magnesium: risks of deficiency, how to correct it, supplement options, potential cognitive and sleep benefits, and more Dec 11, 2023

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In this “Ask Me Anything” (AMA) episode, Peter tackles essential questions about magnesium, beginning with the important roles it plays in the body and why maintaining proper levels is crucial. Peter discusses the harms of magnesium deficiency, how to determine if you're deficient, potential causes of deficiency, and how diet and supplementation can be used to increase magnesium levels. Peter unravels the confusion surrounding magnesium supplementation, discussing the optimal forms and recommended daily intake while addressing concerns about excess consumption. He also explores the potential cognitive and sleep benefits associated with magnesium supplementation. Finally, Peter concludes with a look into his recent experimentation with new exercises to serve as benchmarks to assess his progress and fitness levels as he navigates the aging process.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #54 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

The important roles of magnesium in the body [2:45];
How to determine if you might be deficient in magnesium [10:15];
Addressing migraines related to low magnesium [14:45];
The prevalence of magnesium deficiency [16:30];
Various conditions and drugs that can negatively impact magnesium levels [21:30];
Magnesium-rich foods and factors that impact absorption of magnesium [24:30];
Daily targets for magnesium supplementation and whether it’s possible to take too much [30:15];
The different forms of supplemental magnesium [34:00];
How absorption of magnesium from food compares to absorption from supplements [36:15];
Choosing the right magnesium supplements for optimal absorption [37:15];
The unique ability of magnesium L-threonate to increase brain magnesium concentration [40:15];
Potential cognitive benefits of magnesium [43:00];
Potential sleep benefits of magnesium [48:45];
Takeaways on magnesium and a look into Peter’s personal protocol [53:15];
Peter’s new benchmarks related to exercise and age [58:30]; and
The potential impact of hearing loss on brain health and neurodegeneration [2:04:30]; and
More.

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#281 ‒ Longevity drugs, aging biomarkers, and updated findings from the Interventions Testing Program (ITP) | Rich Miller, M.D., Ph.D. Dec 04, 2023

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Richard Miller is a professor of pathology and the Director of the Center for Aging Research at the University of Michigan, as well as a previous guest on The Drive. In this episode, Rich provides an update on the exciting work of the Interventions Testing Program (ITP), an initiative designed to assess potential life-extending interventions in mice. Rich covers the notable successes like rapamycin, 17⍺-estradiol, and acarbose as well as notable failures like nicotinamide riboside, metformin, and resveratrol, providing valuable lessons about the intricacies of the aging process. Rich delves deep into aging biomarkers and aging rate indicators, unraveling crucial insights into the science of geroprotective molecules. Additionally, Rich discusses some surprising successes of recent molecules tested by the ITP and concludes with an optimistic look at future frontiers, including bridging the gap from mice to humans.

We discuss:

An overview of the Interventions Testing Program (ITP) [3:45];
How the mice used by the ITP are superior for research relative to mouse models used in most research [11:15];
Design of ITP studies, outcomes tested, and metrics of interest [19:00];
The process and challenges of drug formulation for mice [30:00];
Four drugs identified by the ITP that extends the lifespan of mice [36:30];
The success of rapamycin and what it tells us about the biology of aging [43:15];
Other measures of healthspan evaluated by the ITP in stage 2 studies [50:45];
Distinguishing aging rate indicators from biomarkers of aging [57:30];
Aging rate indicators identified through the examination of slow-aging mice [59:15];
Why proteomics are essential to understand changes in the cell [1:12:15];
Unraveling aging rate indicators: dose-effect, duration, and future frontiers [1:21:45];
A closer look at aging rate indicators: bridging the gap from mice to humans [1:27:00];
What do laboratory mice die from? [1:38:45];
Distinguishing between a drug that improves an age-sensitive outcome and a drug that improves all aspects of aging [1:42:00];
The ITP study of 17⍺-estradiol: mechanisms of life extension and surprising sex differences [1:43:30];
Unsuccessful drugs studied by the ITP: resveratrol, metformin, and nicotinamide riboside [1:51:30];
Over-the-counter successes in the ITP: meclizine and astaxanthin [2:01:00];
A senolytic drug, fisetin, fails to extend lifespan [2:07:00];
Can targeting senescent cells slow aging? [2:13:00];
Optimism about future findings [2:16:30]; and
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#280 ‒ Cultivating happiness, emotional self-management, and more | Arthur Brooks Ph.D. Nov 27, 2023

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Arthur Brooks is a social scientist, professor at Harvard University, columnist for The Atlantic, and bestselling author. In this episode, Arthur returns to the podcast to discuss his new book, Build the Life You Want. He delves into the nuanced concept of happiness, differentiating between momentary feelings and overall wellbeing. He explains the importance of understanding one’s personality pattern with respect to positive and negative emotions in order to better self-manage emotions. He delves into the three key elements of happiness, offering practical strategies for enhancing those specific domains through methods such as metacognition, transcendent experiences, discipline, minimizing self-focus while directing attention outward, and more. Through personal examples, Arthur demonstrates that one can actively track well-being levels and take intentional steps to cultivate happiness and enhance overall well-being.

We discuss:

Happiness vs. happy feelings, and how happiness and unhappiness can coexist [4:30];
The six fundamental emotions [8:00];
The evolution and heritability of happiness, and the four personality patterns with respect to positive and negative emotions [17:30];
Navigating relationships: the power of complementarity over compatibility [23:30];
The importance of self-managing your mental habits [25:30];
Enjoyment: one of the three macronutrients of happiness [32:00];
Satisfaction: one of the three macronutrients of happiness [43:45];
The reverse bucket list, metacognition, and other techniques to protect yourself from your limbic system [51:00];
Meaning: one of the three macronutrients of happiness [57:30];
The four quarters of your life and how that relates to the meaning of your life [1:05:00];
Putting metacognition into practice [1:09:00];
What might explain the societal downdrift in happiness over the last few decades? [1:17:00];
Taking charge of your happiness: discipline, transcendent experiences, and other deliberate actions for happiness [1:30:30];
Tracking happiness: biomarkers and micronutrients behind the macronutrients of happiness [1:42:00];
The value in minimizing the self and looking outward [1:49:45];
How Arthur surprised himself with his ability to improve his happiness [1:54:00]; and
More.

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The world’s most important doctor to millions in the war-torn and remote villages of Sudan | Tom Catena, M.D. (#40 rebroadcast) Nov 20, 2023

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To support Tom’s mission and work, please visit: https://africanmissionhealthcare.org/donation/catena/.

In this episode, Tom Catena, a missionary physician who runs Mother of Mercy Hospital in the Nuba Mountains in Sudan, describes some of his extraordinary work as the only doctor in a remote, war-torn region of Africa. In terms of individual lives saved, you could argue that there is no other person on the front lines doing more than Tom. Additionally, we explore the manner in which the Nuba people die, which is in striking contrast to the ubiquity of chronic disease and self-harm in the West, despite the extreme poverty and unimaginable suffering experienced by the Nuba people. Lastly, we discuss the lessons to be gleaned from the Nuba people, who, despite their suffering, live so harmoniously, happily, and resiliently.

We discuss:

Background, medical training, and early days of missionary work in Africa [5:15];
Tom arrives at Mother of Mercy Hospital in the Nuba Mountains of Sudan, civil war breaks out, and his staff evacuates [12:30];
Learning surgery on the job and earning the trust of the community [37:00];
The amazing people of Nuba, and why Nuba feels like home to Tom [47:45];
NY Times article about Tom’s work, and Tom’s new venture on the board of the Aurora Prize Foundation, raising awareness and funds for other missionaries [59:45];
Tom’s mind-blowing ability to deal with chaos while seeing hundreds of patients per day [1:12:00];
The most afraid Tom has ever been, and how he copes with the emotional trauma of his daily experiences [1:19:45];
The basic tools, technologies, and medicines that Tom is lacking that could save many lives [1:30:00];
The logistical challenge of helping Tom’s hospital, and what Tom really needs [1:35:15];
Diseases in the adult population [1:38:30];
Living without possessions, finding meaning, and being a missionary [1:55:45];
Happiness, sense of purpose, and suicide: contrasting the US with Nuba [2:07:15];
Other than donations, is there a way people can help Tom and other similar causes? [2:15:15];
The food in Nuba [2:18:30];
Tom’s annual bout of malaria [2:23:45];
Patients Tom will never forget [2:26:00];
Resources for people wanting to get involved in helping Tom’s work [2:31:00];
Peter tells a story that defines Tom [2:32:00]; and
More.

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#279 - AMA #53: Metabolic health & pharmacologic interventions: SGLT-2 inhibitors, metformin, GLP-1 agonists, and the impact of statins Nov 13, 2023

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In this “Ask Me Anything” (AMA) episode, Peter explores various pharmacologic tools commonly utilized to improve metabolic health and treat diabetes, including SGLT-2 inhibitors, metformin, and GLP-1 agonists. He examines the available data on these drugs, assessing their comparative effectiveness and their potential in the context of lifestyle interventions. Additionally, he offers insights into whether SGLT2 inhibitors hold promise as geroprotective agents beyond their effects on glycemic control. Next, Peter analyzes the relationship between statin usage and the risk of developing insulin resistance and type 2 diabetes, investigating possible causal pathways and providing insights into strategies for risk reduction. He offers insights on monitoring adverse statin effects and evaluating the need for adjustments, ultimately weighing the trade-off between the risk to overall metabolic health against the benefits of reducing apoB levels through statin use.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #53 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Pharmacologic tools for improving metabolic health, and the relationship between statins and insulin resistance [2:00];
SGLT-2 inhibitors: how they work and help to manage type 2 diabetes [4:15];
The history of SGLT2 inhibitors – from discovery to the current state [10:15];
Comparing the various FDA-approved SGLT2 inhibitors [15:00];
Other beneficial effects of SGLT2 inhibitors outside of glycemic control [20:15];
Exploring SGLT2 inhibitors as potential geroprotective molecules [22:45];
The side effects and risks associated with SGLT2 inhibitors [31:45];
Medications, lifestyle interventions, and other considerations for treating diabetes and improving metabolic health [37:45];
Metformin as a tool for pre-diabetics, and how metformin compares to lifestyle interventions [44:00];
How GLP-1 agonists compare to metformin and SGLT2 inhibitors in terms of glycemic control and weight loss [49:15];
Exploring the relationship between statin use and the risk of developing insulin resistance and type 2 diabetes [52:30];
Possible mechanisms of statin-induced insulin resistance and diabetes, and potential mitigation strategies [1:04:30];
How to monitor for adverse effects of statin use and assess the need for adjustments [1:11:45];
Weighing the benefits and risks of statin use: does the diabetes risk outweigh the benefits of lowering apoB with a statin? [1:15:30];
Parting thoughts [1:20:45]; and
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#278 ‒ Breast cancer: how to catch, treat, and survive breast cancer | Harold Burstein, M.D., Ph.D. Nov 06, 2023

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Harold (Hal) Burstein is an internationally renowned breast cancer expert. In this episode, Hal discusses a broad range of topics related to breast cancer, starting with the intricacies of breast anatomy and the endocrinological factors at play. He covers the spectrum of breast cancer, from precancerous lesions to invasive breast cancer, classifying these conditions into a helpful framework. He delves into various screening methods, including self-exams, mammograms, ultrasounds, and MRIs, and addresses the ongoing debate surrounding early screening and detection. Hal provides insights into the latest advancements in cancer treatment, offering valuable guidance for individuals to understand their unique circumstances within the three primary categories of breast cancer. Finally, Hal delves into the role of genetics in breast cancer and brings attention to the less commonly addressed issue of male breast cancer.

We discuss:

The prevalence and mortality rate of breast cancer in women [4:15];
The anatomy of the breast and the complex factors behind breast cancer development [6:30];
The three main categories of breast cancer [16:45];
Breast cancer risk: the impact of menopause, estrogen, breast density, obesity, and more [21:15];
Finding and evaluating lumps in the breast [25:30];
Identifying and treating precancerous lesions like ductal carcinoma in situ (DCIS) [31:00];
Post-lumpectomy for DCIS: standard of care, future risk of cancer, and pros and cons of radiation and other preventative options [41:15];
Lobular carcinoma in situ (LCIS): how it differs from DCIS in terms of treatment and future risk of invasive cancer [55:00];
Breast cancer screening: mammography, ultrasound, MRI, and more [1:03:45];
Invasive breast cancer: pathology report, surgery, and survival [1:11:00];
The argument for aggressive screening for breast cancer [1:22:15];
Advances in the treatment of breast cancer, adjuvant therapy, and neoadjuvant therapy [1:27:00];
The use of hormone replacement therapy in women who are in remission from breast cancer [1:41:15];
The role of genetics in breast cancer [1:44:45];
The importance of multidisciplinary care delivered by cancer centers [1:53:15];
Breast cancer in men [2:03:30];
Parting thoughts and takeaways [2:05:45]; and
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#277 ‒ Food allergies: causes, prevention, and treatment with immunotherapy | Kari Nadeau, M.D., Ph.D. Oct 30, 2023

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Kari Nadeau is a physician scientist with expertise in treating food allergies. In this episode, Kari first explains the fascinating workings of the immune system, exploring how it adeptly defends against bacteria and viruses but how the same system can lead to food allergies. She proceeds to explore the complexities of food allergies, detailing their typical developmental patterns, underscoring the significance of preventative approaches like early exposure, and highlighting the potentially life-threatening nature of severe food allergies. Kari illuminates the latest advancements in immunotherapies that not only mitigate allergy severity but also hold the potential to completely cure the patient. Additionally, Kari shares her concerns about the increasing levels of air pollution, elucidating its adverse effects on health while providing valuable suggestions for reducing exposure.

We discuss:

Kari’s motivation to study food allergies [4:00];
Overview of the immune system and the family of immunoglobulins [9:00];
How our immune system fights viruses, bacteria, or fungi, and some exceptions to the rule [13:00];
Why our immune system is generally better at fighting viruses than bacterial infections [18:45];
Differentiating a food sensitivity from a food allergy, and a discussion about celiac disease [25:30];
How food allergies develop, why they can be lethal, and factors contributing to the uptrend in food allergies [35:45];
The role of environmental factors in the onset of food allergies and strategies for prevention [50:15];
How immunotherapy helps to overcome, and even cure, food allergies [1:04:15];
Can immunotherapy work for environmental allergens like pollen? [1:24:00];
Air pollution: impact on health and tips for reducing your risk [1:25:30];
Resources for those wanting to learn more or find clinical trials related to food allergies [1:40:45]; and
More.

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#276 ‒ Special episode: Peter answers questions on longevity, supplements, protein, fasting, apoB, statins, and more Oct 23, 2023

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In this special episode of The Drive, Peter discusses a variety of topics, breaking away from the typical deep-dive format to explore a wide range of common questions submitted by listeners. Peter tackles subjects like the viability of living to 120 and beyond, addressing some of the optimistic theories regarding achievement of this remarkable feat. Peter then shares his drug and supplement regimen while emphasizing how individualized these protocols need to be. The conversation also touches on lowering apoB, the long-term use of statins, the myth of good vs. bad cholesterol, the complexities of nutrition research, the quest for the ideal diet, and Peter's strategies for hitting daily protein goals. Peter finishes with a discussion about his favorite health-tracking wearables, the role of CGM in non-diabetics, and more.

We discuss:

Overview of topics and previous episodes of a similar format [2:45];
The viability of living to 120 and beyond: some optimistic theories [4:45];
The potential of mTOR inhibition as a mid-life intervention, and longevity potential for the next generation [13:30];
A framework for thinking about geroprotective drugs and supplements in the context of a lack of aging biomarkers [17:00];
Supplements Peter takes and how his regimen has changed in the last year [26:15];
Pharmacologic strategies to lower ASCVD risk, the limitations of statins, nutritional interventions, and more [36:15];
Misnomers about cholesterol [48:00];
Why nutritional research is so challenging, some general principles of nutrition, and why Peter stopped doing prolonged fasts [50:45];
Optimizing protein intake [59:45];
Wearables for sleep and exercise, continuous glucose monitors (CGM), and a continuous blood pressure monitor on the horizon [1:04:45]; and
More.

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#275 - AMA #52: Hormone replacement therapy: practical applications and the role of compounding pharmacies Oct 16, 2023

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In this "Ask Me Anything" (AMA) episode, the discussion zeroed in on the practical application of hormone replacement therapy in women. Peter walks through the signs, symptoms, and hormonal changes in women approaching – and going through – menopause. He provides an overview of the FDA-approved HRT formulations and explains how women might go about choosing the right option for themselves. Peter also describes the significant changes in testosterone levels in women over time and the options, as well as the considerations and challenges of testosterone replacement therapy (TRT) for women. Lastly, Peter highlights the necessary role of compounding pharmacies in HRT, underscores concerns regarding the quality and sterility of compounded drugs, and offers guidance on locating a trustworthy pharmacy.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #52 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Why hormone replacement therapy is such an important topic [2:00];
The onset of menopause: symptoms, blood tests, and when to consider HRT [6:00];
Tests that may provide indications of perimenopause and their implications for fertility [9:15];
Vasomotor symptoms: hormonal changes that cause hot flashes/night sweats, and HRT therapies that can help [13:45];
The role of estrogen in menopausal HRT [17:30];
The limited role of progesterone in HRT protocols [25:15];
What is a “bioidentical” hormone? [28:30];
Overview of the FDA-approved HRT formulations [31:45];
Determining HRT dosing and considerations for perimenopausal women [37:45];
Choosing the right HRT formulation: pros and cons [43:30];
Examining the link between certain forms of estrogen and breast cancer [46:45];
Changes in testosterone levels in women over time and why it matters [50:00];
Recognizing low testosterone in women: common symptoms and diagnosis [53:45];
Testosterone replacement therapy for women: options, considerations, and challenges [57:30];
The long-term use of testosterone in women: examining the limited data [1:00:15];
What is a compounding pharmacy? [1:09:30];
Reasons to opt for a compounding pharmacy over a pharmacy that adheres to stricter regulations [1:16:00];
The tragic incidents that heightened concerns about compounding pharmacies [1:20:45];
Tips for finding a reputable compounding pharmacy [1:27:45]; and
More.

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#274 - Performance-enhancing drugs and hormones: risks, rewards, and broader implications for the public | Derek: More Plates, More Dates Oct 09, 2023

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We discuss:

Derek’s interest in weightlifting and experimentation with anabolic steroids at a young age [3:15];
Derek’s experience acquiring steroids from underground labs and the potential long-term fertility concerns early in his bodybuilding career [12:00];
The backstory on More Plates, More Dates and Derek’s unique ability to blend scientific knowledge with personal observation [17:00];
Growth hormone – from extreme use-cases to the more typical – and the misconception that it’s the “elixir of life” [21:30];
Growth hormone 101: definition, where it comes from, and the challenges of measuring it [28:45];
Does exogenous growth hormone compromise one’s ability to make endogenous growth hormone? [40:00];
The use of growth hormone in restoration of tissue during periods of healing [42:00];
Growth hormone-releasing peptides to increase endogenous GH: various peptides, risks, benefits, and comparison to exogenous growth hormone [48:45];
The role of growth hormone in building muscle and burning fat, as well as its effects on sleep and daytime lethargy [1:02:30];
The evolution of drug use in the sport of bodybuilding [1:10:30];
What explains the protruding abdomens on some bodybuilders and athletes? [1:20:30];
Death of bodybuilders [1:26:00];
The complex interplay of hormones, and the conversion of testosterone into metabolites like DHT and estrogen [1:33:45];
Post-finasteride syndrome and how Derek successfully treated his hair loss [1:43:15];
Testosterone replacement therapy: compelling use-cases, side effects, and optimal dosing schedules [1:57:15];
Aromatase inhibitors to suppress estrogen, and the misconceptions around estrogen in men [2:16:00];
Other hormones beyond testosterone for male sex hormone replacement [2:21:00];
The history of anabolic compounds, and the differing effects of various anabolic testosterone derivatives and related drugs [2:24:30];
Use of SARMs by bodybuilders [2:29:45];
Anabolic steroid and testosterone regimens of professional bodybuilders and the downstream consequences [2:36:15];
The challenge of accurate hormone testing in the presence of anabolic steroids and supplements [2:44:45];
The use of Clomid, hCG, and enclomiphene [2:47:15];
Concerns about fertility: comparing the use of testosterone and hCG [3:00:30];
The use of BPC-157 peptide for healing injuries [3:12:00]; and
More.

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#273 ‒ Prostate health: common problems, cancer prevention, screening, treatment, and more | Ted Schaeffer, M.D., Ph.D. Oct 02, 2023

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Ted Schaeffer is an internationally recognized urologist who specializes in prostate cancer. In this episode, Ted delves deep into the realm of prostate health, starting with strategies for vigilance and effective management of the issues that can arise with aging, including urinary symptoms, prostatitis, pelvic pain, and prostate inflammation. Ted sheds light on the popular drug finasteride, renowned for its dual purpose in prostate shrinkage and hair loss prevention, as well as the contentious topic of post-finasteride syndrome. Ted then shifts to the topic of cancer, explaining how androgens, genetics, and non-genetic factors contribute to the pathogenesis of prostate cancer. He provides valuable insights into cancer screening, examining blood-based screening tools like PSA and the use of MRI in facilitating biopsies and their interpretation. Finally, he explores the various treatment options for prostate cancer, including surgical interventions, androgen deprivation therapy, and more.

We discuss:

Changes to the prostate with age and problems that can develop [3:45];
Behavioral modifications to help manage nocturnal urinary frequency and other lower urinary tract symptoms [8:30];
Pharmacologic tools for treating nocturnal urinary frequency and lower urinary tract symptoms [16:30];
Surgical tools for treating symptoms of the lower urinary tract [26:15];
HoLEP surgery for reducing prostate size [32:30];
Prostate size: correlation with cancer and considerations for small prostates with persistent symptoms [40:30];
Prostatitis due to infection: symptoms, pathogenesis, and treatment [46:45];
Prostatitis caused by factors besides infection [58:45];
How to minimize risk of urosepsis in patients with Alzheimer’s disease [1:05:00];
Prostate cancer: 5-alpha reductase inhibitors, how androgens factor into pathogenesis, and more [1:10:00];
Post-finasteride syndrome [1:18:15];
The relationship between testosterone and DHT and the development of prostate cancer over a man's lifetime [1:26:30];
How genetic analysis of a tumor can indicate the aggressiveness of cancer [1:35:15];
Pathogenesis and genetic risk factors of prostate cancer and the use of PSA to screen for cancer [1:37:45];
Non-genetic risk factors for prostate cancer [1:45:45];
Deep dive into PSA as a screening tool: what is PSA, definition of terms, and how to interpret results [1:56:30];
MRI as a secondary screening tool and the prostate biopsy options [2:13:15];
Ted’s ongoing randomized trial comparing different methods of prostate biopsy [2:24:00];
Determining when a biopsy is necessary, interpreting results, explaining Gleason score, and more [2:27:00];
Implications of a Gleason score of 7 or higher [2:46:45];
Metastasis of prostate cancer to different body locations, treatment options, staging, and considerations for patients' quality of life and survival [2:53:30];
How prostate cancer surgery has improved [3:09:30];;
Questions to ask your neurologist if you are considering prostatectomy for cancer [3:21:45]; and
More.

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#272 ‒ Rapamycin: potential longevity benefits, surge in popularity, unanswered questions, and more | David Sabatini, M.D., Ph.D. and Matt Kaeberlein, Ph.D. Sep 25, 2023

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In this episode of The Drive, Peter welcomes guests David Sabatini and Matt Kaeberlein, two world-leading experts on rapamycin and mTOR. David and Matt begin by telling the fascinating story of the discovery of rapamycin and its brief history as a pharmacological agent in humans. They then unravel the function of mTOR, a central regulator of numerous biological processes, and they discuss the pathways through which rapamycin exerts its potential benefits on lifespan. They touch upon initial studies that suggested rapamycin may have geroprotective effects and the ongoing research that continues to shed light on this unique molecule. Furthermore, they discuss the elusive details surrounding the frequency and dosing of rapamycin use in humans, and Peter emphasizes his reservations about indiscriminately prescribing rapamycin as a longevity drug for patients.

We discuss:

David and Matt’s expertise in mTOR and rapamycin [3:00];
The discovery of rapamycin and its first use in humans as an immunosuppressant [13:15];
The emergence of rapamycin as a molecule with the potential to prolong lifespan [19:30];
The groundbreaking rapamycin study on mouse lifespan extension and the open questions about the timing and frequency of dosing [26:00];
Explaining mTOR and the biology behind rapamycin’s effects [35:30];
Differences in how rapamycin inhibits mTOR complex 1 (MTORC1) versus mTOR complex 2 (MTORC2) [45:15];
Reconciling the biochemical mechanism of rapamycin with its longevity benefit [49:15];
Important discoveries about the interplay of amino acids (leucine in particular) and mTOR [54:15];
Reconciling rapamycin-mediated mTOR inhibition with mTOR's significance in building and maintaining muscle [1:01:30];
Unanswered questions around the tissue specificity of rapamycin [1:08:30];
What we know about rapamycin’s ability to cross the blood-brain barrier and its potential impacts on brain health and neurodegeneration [1:13:45];
Rapamycin may act as an immune modulator in addition to immunosuppressive effects [1:21:30];
Might rapamycin induce changes in T cell methylation patterns, potentially reversing biological aging? [1:34:15];
Rapamycin side effects and impacts on mental health: fascinating results of Matt’s survey on off-label rapamycin use [1:42:00];
The impact of taking rapamycin in people who contracted COVID-19: more insights from Matt’s survey [1:51:15];
What David would like to study with mTOR inhibitors [1:54:45];
Joan Mannick’s studies of RTB101 and other ATP-competitive inhibitors of mTOR [2:00:30];
The impact of mTOR inhibition on autophagy and inflammation and a discussion of biomarkers [2:10:00];
The Dog Aging Project: what we’ve learned and what’s to come from testing rapamycin in companion dogs [2:17:30];
Preliminary results of primate studies with rapamycin [2:24:45];
Dosing of rapamycin [2:27:45];
The effect of rapamycin on fertility [2:36:45];
The outlook for future research of rapamycin and the development of rapalogs [2:39:00]; and
More.

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#271 - AMA #51: Understanding and improving your metabolic health Sep 18, 2023

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In this “Ask Me Anything” (AMA) episode, Peter dives deep into the critical topic of metabolic disease. He first sheds light on how poor metabolic health drives up the risk of developing other chronic diseases such as cardiovascular disease, cancer, neurodegenerative disease, and overall mortality. He explores the array of metrics and tests used to assess metabolic health, underscoring his preferred methodologies utilized with patients. Finally, Peter provides an overview of the factors one can manipulate in order to improve metabolic health.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #51 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Importance of metabolic health and a primer on metabolic disease [1:30];
How poor metabolic health increases one’s risk for other chronic diseases [6:00];
How useful is body weight and BMI for estimating metabolic health? [9:45];
Overview of various tests and metrics used to understand metabolic health [12:15];
Traditional biomarkers and how Peter’s point of view may differ from the guidelines [15:00];
Lactate: insights into metabolic health through fasting and resting lactate levels [17:00];
Zone 2 output: an important functional test of metabolic health [20:00];
Cardiopulmonary exercise testing (CPET) [25:45];
Visceral adipose tissue (VAT): what is VAT and how does it impact health? [27:00];
Oral glucose tolerance test (OGTT): how it works and why it is such an important metric for assessing metabolic health [32:15];
The utility of a continuous glucose monitor (CGM) [40:45];
Liver function and NAFLD [42:15];
Sleep as an intervention [46:00];
Exercise as an intervention [53:15];
Diet and nutrition [59:00];
How reducing stress can improve metabolic health [1:05:15]; and
More.

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#270 ‒ Journal club with Andrew Huberman: metformin as a geroprotective drug, the power of belief, and how to read scientific papers Sep 11, 2023

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Andrew Huberman, Professor of Neurobiology at Stanford University and host of the Huberman Lab podcast joins us in a special journal club episode. Peter and Andrew each present a recent paper that sparked their interests, delving into the findings, dissecting their significance, discussing potential confounders and limitations, and exploring remaining questions. Importantly, they share their methodologies for comprehending research studies, providing valuable insights for listeners to navigate this process independently. Peter presents an epidemiological study reevaluating a noteworthy metformin result that intrigued the anti-aging community, leading to discussions on metformin's geroprotective potential (or lack thereof) and the current lack of aging biomarkers. Andrew introduces a paper examining how our beliefs about the medications we take influence their biological effects, distinguishing the "belief effect" from a placebo effect and highlighting its exciting implications for the future.

We discuss:

The motivation behind this journal club conversation [2:45];
Why Peter chose a paper on metformin, how metformin works, and why it generated excitement as a longevity-enhancing agent [9:00];
Defining insulin resistance and its underlying causes [16:15];
Metformin as a first-line treatment for type 2 diabetes, and Peter’s evolving interest in metformin as a geroprotective drug [22:00];
Defining the term “geroprotection” [24:45];
The 2014 study that got the anti-aging community interested in metformin [26:00];
Peter presents the 2022 paper that repeats the analytical approach from the 2014 Bannister study [33:15];
Greater mortality in the metformin group: how results differed between the 2022 paper and the 2014 paper [40:00];
Understanding statistical significance, statistical power, sample size, and why epidemiology uses enormous cohorts [51:45];
Interpreting the hazard ratios from the 2022 metformin study, and the notable takeaways from the study [56:45];
Drugs that may extend lifespan, why Peter stopped taking metformin, and a discussion of caloric restriction [1:08:45];
Current thoughts on the use of metformin for longevity [1:21:00];
Could there be any longevity benefit to short periods of caloric restriction? [1:22:45];
Peter and Andrew’s process for reading scientific papers [1:26:45];
The biological effects of belief, and how “belief effects” differ from placebo effects [1:32:30];
The neurobiology of nicotine: a precursor conversation before delving into the paper Andrew chose [1:39:45];
Andrew presents a paper that demonstrates the impact of belief [1:45:30];
Analyzing the fascinating results of the Perl paper [1:54:30];
Exciting implications of the findings about “belief” reported by Perl and colleagues [2:03:15]; and
More.

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#269 - Good vs. bad science: how to read and understand scientific studies Sep 04, 2023

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This special episode is a rebroadcast of AMA #30, now made available to everyone, in which Peter and Bob Kaplan dive deep into all things related to studying studies to help one sift through the noise to find the signal. They define various types of studies, how a study progresses from idea to execution, and how to identify study strengths and limitations. They explain how clinical trials work, as well as biases and common pitfalls to watch out for. They dig into key factors that contribute to the rigor (or lack thereof) of an experiment, and they discuss how to measure effect size, differentiate relative risk from absolute risk, and what it really means when a study is statistically significant. Finally, Peter lays out his personal process when reading through scientific papers.

We discuss:

The ever-changing landscape of scientific literature [2:30];
The process for a study to progress from idea to design to execution [5:00];
Various types of studies and how they differ [8:00];
The different phases of clinical trials [19:45];
Observational studies and the potential for bias [27:00];
Experimental studies: randomization, blinding, and other factors that make or break a study [44:30];
Power, p-values, and statistical significance [56:45];
Measuring effect size: relative risk vs. absolute risk, hazard ratios, and “number needed to treat” [1:08:15];
How to interpret confidence intervals [1:18:00];
Why a study might be stopped before its completion [1:24:00];
Why only a fraction of studies are ever published and how to combat publication bias [1:32:00];
Frequency of training for Olympic weightlifting [1:22:15];
How post-activation potentiation (and the opposite) can improve power training and speed training [1:24:30];
The Strongman competition: more breadth of movement, strength, and stamina [1:32:00];
Why certain journals are more respected than others [1:41:00];
Peter’s process when reading a scientific paper [1:44:15]; and
More.

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#268 ‒ Genetics: testing, therapy, editing, association with disease risk, autism, and more | Wendy Chung, M.D., Ph.D. Aug 28, 2023

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Wendy Chung is a board-certified clinical and molecular geneticist with more than 25 years of experience in human genetic disease research. In this episode, Wendy delves deep into the world of genetics by first exploring the historical landscape of genetics prior to decoding the human genome, contrasting it with what we know today thanks to whole genome and exome sequencing. She provides an overview of genetic testing by differentiating between various genetic tests such as direct-to-consumer, clinical, whole genome sequencing, and more. Additionally, Wendy unravels the genetic underpinnings of conditions such as PKU, breast cancer, obesity, autism, and cardiovascular disease. Finally, Wendy goes in depth on the current state and exciting potential of gene therapy while also contemplating the economic implications and ethical nature of gene editing.

We discuss:

Wendy’s interest in genetics and work as a physician-scientist [2:45];
The genetics of phenylketonuria (PKU), a rare inherited disorder [5:15];
The evolution of genetic research: from DNA structure to whole genome sequencing [18:30];
Insights and surprises that came out of the Human Genome Project [28:30];
Overview of various types of genetic tests: direct-to-consumer, clinical, whole genome sequencing, and more [34:00];
Whole genome sequencing [39:30];
Germline mutations and the implications for older parents [45:15];
Whole exome sequencing and the importance of read depth [50:30];
Genetic testing for breast cancer [54:00];
What information does direct-to-consumer testing provide (from companies like 23andMe and Ancestry.com)? [1:01:30];
The GUARDIAN study and newborn genetic screening [1:06:30];
Treating genetic disease with gene therapy [1:18:00];
How gene therapy works, and the tragic story of Jesse Gelsinger [1:22:00];
Use cases for gene therapy, gene addition vs. gene editing, CRISPR, and more [1:28:00];
Two distinct gene editing strategies for addressing Tay-Sachs and fragile X syndrome [1:37:00];
Exploring obesity as a polygenic disease: heritability, epigenetics, and more [1:41:15];
The genetics of autism [1:48:45];
The genetics of cardiovascular disease [2:01:45];
The financial costs and economic considerations of gene therapy [2:06:15];
The ethics of gene editing [2:12:00];
The future of clinical genetics [2:21:00]; and
More.

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#267 ‒ The latest in cancer therapeutics, diagnostics, and early detection | Keith Flaherty, M.D. Aug 21, 2023

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Keith Flaherty is the director of clinical research at the Massachusetts General Hospital Cancer Center and a previous guest on The Drive. In this episode, Keith first delves into the statistics on cancer's prevalence as we age, underscoring the significance of finding effective treatments and early detection methodologies. He touches on the history of cancer therapeutics and illuminates the notable enhancements in cancer therapy within the last decade that are setting the stage for a promising future. He goes into detail on the potential of immunotherapy and therapies that can combat cancer’s evasive tactics while explaining some of the existing challenges around specificity, cost, and scalability. Additionally, Keith highlights the significant leap in early detection methodologies, namely liquid biopsies, which have the potential not only to determine if a cancer is present in an early stage, but also identify the possible tissue of origin.

We discuss:

Keith’s interest and expertise in cancer [3:15];
Cancer deaths by decade of life, and how cancer compares to other top causes of death [7:00];
The relationship between hormones and cancer [12:00];
The link between obesity and cancer [18:45];
Current state of treatments for metastatic cancer and reasons for the lack of progress over the decades [22:30];
The interplay between the immune system and cancer cells [32:00];
Different ways cancer can suppress the immune response, and how immunotherapy can combat cancer’s evasive tactics [39:30];
Elimination of a substantial portion of cancers through immune cell engineering faces challenges of specificity, cost, and scalability [52:15];
Why TIL therapy isn’t always effective, and the necessity for multimodal therapy to address various aspects of the cancer microenvironment [1:01:00];
Potential developments in cancer therapy over the next five years: T-cell activation, metabolic interventions, targeting tumor microenvironments, and more [1:06:30];
The challenge of treating metastatic cancer underscores the importance of early detection to improve survivability [1:19:15];
Liquid biopsies for early detection of cancer and determining the possible tissue of origin [1:24:45];
Commercially available cancer screening tests [1:33:45];
How to address the disparity in cancer care, and the exciting pace of progress for cancer detection and treatment [1:40:15]; and
More.

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#266 - AMA #50: Genetics: how they impact disease risk, what you can do about it, testing, and more Aug 14, 2023

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In this "Ask Me Anything" (AMA) episode, Peter delves into the realm of genetics, unraveling its connection to disease and emphasizing the value of understanding one's genetic risks. He elucidates essential background knowledge on genetics before delving into the myriad reasons why individuals might consider genetic testing. Peter differentiates scenarios where genetic testing provides genuine insights from those where it may not be as useful. From there, Peter explores a comprehensive comparison of commercial direct-to-consumer genetic tests, providing insights on interpreting results and identifying the standout options for gaining insights into personal health.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #50 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Defining the term “genetics” and why it’s important [2:15];
What is DNA, and how does it impact our biology and traits? [5:45];
How are genetics passed down from parent to child? [8:45];
How much do genes vary across individuals? [13:00];
Which traits are determined by genetics versus experience or environmental factors? [17:00];
Reasons for genetic testing [22:30];
What exactly is being measured by a genetic test? [29:15];
Testing for monogenic disorders [35:15];
Understanding polygenic risk [39:30];
Is genetic testing more important for someone who doesn’t know their family history? [40:45];
What does it mean to be positive for a particular variant? [43:00];
What does it mean to be negative for a particular variant? [45:45];
How does someone get genetic testing through their healthcare provider, and how are these tests performed? [48:15];
The financial cost of various genetic tests [54:30];
Could having a risk allele for a disease result in an increase in one’s insurance premium? [57:15];
Other risks associated with genetic testing [59:00];
How do commercial, direct-to-consumer genetic tests compare to the information one might receive from clinical genetic testing? [1:01:45];
Are certain direct-to-consumer tests better than others? [1:03:45];
How long until whole genome sequencing becomes genuinely useful? [1:16:00];
How useful are personalized dietary recommendations based on genetics? [1:18:15];
Final thoughts and advice regarding genetic testing [1:20:00]; and
More.

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#265 - Time, productivity, and purpose: insights from Four Thousand Weeks | Oliver Burkeman Aug 07, 2023

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Oliver Burkeman is the author of The New York Times best-seller Four Thousand Weeks: Time Management for Mortals. In this episode, Oliver delves into the pervasive idea that time can be mastered, exploring whether maximizing productivity is an attainable goal or a perpetual trap. He discusses the allure of attempting to control time—and, therefore, the future—and shares his personal journey of experimenting with diverse time management techniques that failed to deliver the emotional satisfaction he sought. Ultimately, they explore the mismatch between being a finite human and existing in a world of infinite possibilities and how all of these concepts intertwine with finding a sense of purpose and meaning. Additionally, Oliver shares insights from his book on productivity, using our time wisely, and embracing our finitude to live a more fulfilling life.

We discuss:

Oliver’s experience that led him to write the book Four Thousand Weeks [3:15];
Human’s relationship with time and the struggle with the finite nature of time [7:15];
How productivity can be a trap [11:00];
The fallacy that being more efficient will open up more time and bring a feeling of control [16:45];
The paradoxical nature of trying too hard to be present in the current moment [22:45];
The value of relationships in meaningful experiences and fulfillment, and how time gets its value from being shared [26:45];
The importance of time synchronicity [36:00];
Identifying your biggest priorities and the paradox of wanting to do more than you have time for [41:00];
Oliver’s moment of clarity in 2014 [47:15];
The role of a sense of purpose in fulfillment [50:15];
Reconciling the finite nature of time and letting go of trying to master your time [59:00];
Why we tend to have a future-focused attitude and how to combat that with atelic activities [1:05:45];
The power of shifting your perspective about time and your experiences [1:12:45];
How to operationalize the three principles for the dilemma of finite time [1:20:15];
Harnessing the power of patience in the face of a problem or experience [1:28:00];
The value of incrementalism for being productive [1:34:15];
Embracing your finitude with curiosity [1:38:00];
Acting on an idea in the moment rather than letting the idea be the obstacle [1:41:15]; and
More.

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#264 ‒ Hip, knee, ankle, and foot: common injuries, prevention, and treatment options Jul 31, 2023

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Adam Cohen is an orthopedic surgeon with expertise in sports medicine. In this episode, Adam breaks down the anatomy of the lower extremities: the hip, knee, ankle, and foot. He explains in detail the common injuries, sources of pain, and what leads to the development of arthritis. He lays out the non-surgical and surgical treatment options as well as the factors that determine whether surgery is appropriate. The discussion includes various procedures like hip replacement, knee replacement, ACL reconstruction, repair of meniscus tears, and more. Additionally, Adam sheds light on the utility of biological therapies like stem cells and platelet-rich plasma (PRP) and how they compare to more traditional approaches.

We discuss:

Anatomy of the hip, hip dysplasia in infants, and the development of arthritis [3:00];
Diagnosing hip pain in people under 50, stress fractures in the femoral neck, and more [11:15];
Common hip injuries, gender differences, and problems that occur when the hip isn’t formed normally [19:30];
Advancements in hip replacement surgery [25:15];
Common hip problems in people over age 60 [27:30];
The importance of muscular strength around the hips for injury prevention [30:30];
Hip fractures due to osteopenia and osteoporosis [36:00];
The utility of biological therapies like stem cells and platelet-rich plasma (PRP) [40:30];
Cortisone as a treatment to delay the need for surgical intervention [53:30];
Anatomy of the knee [56:30];
Are activities like running that amplify forces bad for the knee? [59:45];
Risk of future knee issues and arthritis following an ACL tear or other substantial knee injury [1:04:30];
How the ACL injury happens and how it is repaired [1:08:30];
Arthritis of the knee [1:19:00];
Meniscus tears: how they happen and when surgery is appropriate [1:21:30];
Total knee replacement: when it’s appropriate and how the recovery process compares to hip replacement [1:30:30];
Learning from elite athletes, heart rate recovery, V02 max, and other metrics [1:58:45];
Surgical vs. non-surgical approaches to various knee injuries [1:40:45];
Achilles tendon: tendinitis, rupture of the Achilles tendon, and prevention strategies [1:44:15];
Anatomy of the ankle and foot [1:49:00];
Common injuries to the ankle and foot [1:51:15];
Tips for finding a good orthopedic surgeon [2:01:45]; and
More.

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#263 ‒ Concussions and head trauma: symptoms, treatment, and recovery | Micky Collins, Ph.D. Jul 24, 2023

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Michael “Micky” Collins is an internationally renowned expert in sports-related concussions and a consultant for multiple professional sports organizations. In this episode, Mickey first explains the definition and diagnosis of a concussion, as well as the diverse signs and symptoms associated with different types of concussions. He discusses the risk factors that contribute to increased susceptibility and/or severity of concussions in certain individuals, emphasizes the significance of prompt treatment, and uses case studies to illustrate the latest in treatment protocols and recovery process. Additionally, Mickey provides insight into the evolving field of concussion treatments, including the exploration of hyperbaric oxygen and synthetic ketones. He gives advice to parents of kids who play sports and discusses the promising prospects in the realm of concussion management.

We discuss:

Micky’s interest in concussion and how he started the first concussion clinic [3:15];
Concussion: definition, pathophysiology, and risk factors making someone more susceptible [9:45];
Symptoms of concussion, predictors of severity, and the importance of early and effective treatment [20:00];
The six types of concussion, the effectiveness of treatment, and factors that impact recovery [25:45];
The importance of seeing a specialist and the prognosis for recovery [30:00];
Case study of a racecar driver who suffered a vestibular concussion [32:15];
Why vestibular concussions are particularly problematic [42:45];
A treatment plan for the racecar driver, possible use of medications, and how to address the root cause [45:45];
Exploring alternative treatments: hyperbaric oxygen, synthetic ketones, and more [52:00];
The natural history of a concussion if untreated and the effect, if any, of concussion on subsequent risk of brain disease [57:15];
Chronic traumatic encephalopathy (CTE) [1:01:45];
Advice for parents of kids who play sports: when and where to seek treatment for a possible concussion [1:04:45];
Is there any evidence that the APOE4 genotype increases susceptibility to concussion or TBI? [1:10:15];
The increased risk of concussions in older adults and a case study of a 90-year-old patient who suffered a head injury in a fall [1:11:15];
Funding for concussion research and fellowship programs to train concussion specialists [1:15:30]; and
More.

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#262 - AMA #49: Heart rate recovery, strength training, rucking, kidney function, and brain health Jul 17, 2023

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In this "Ask Me Anything" (AMA) episode, Peter goes into depth on the topic of brain health, starting with how Alzheimer's disease is diagnosed, the significance of blood-based biomarkers in diagnosis, and what the various APOE gene variants mean in terms of a person's risk of developing Alzheimer's disease. Next, Peter discusses the various strategies for preventing Alzheimer's disease and neurodegeneration. He touches briefly on exercise as a potent tool, but focuses more on lesser-known factors that could impact brain health, such as nutrition supplementation, lipid management, brain games, sauna, oral health, hearing loss, and more.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #49 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Topics: exercise, kidneys, and brain health [1:30];
Rucking: advice for beginners, proper load, packs, and shoes [4:30];
Rucking for women, bone health, using a treadmill, zone 2, and more [11:45];
Building vs. maintaining: when and how to transition from the goal of building muscle and strength to focusing on maintenance [16:00];
Should you lift weights before or after a cardio session? [24:00];
Heart rate recovery: defining heart rate recovery and how it relates to cardiovascular fitness [28:45];
How to measure heart rate recovery, and what is considered a "good" heart rate recovery [33:15];
How kidney health and function typically measured [42:30];
Differentiating between creatine and creatinine [48:15];
The cystatin C blood test as a practical way to assess kidney health [52:45];
How kidney function impacts lifespan and the five stages of kidney disease [59:15];
Slowing the decline of kidney function [1:08:15];
The main drivers of kidney disease [1:11:15];
The importance of managing homocysteine levels for brain health [1:14:00];
The relationship between alcohol consumption and brain health [1:21:30]; and
More.

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#261 ‒ Training for The Centenarian Decathlon: zone 2, VO2 max, stability, and strength | Peter Attia, M.D. Jul 10, 2023

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In this special episode filmed live in front of readers of Outlive, Peter answers questions revolving around his concept of the centenarian decathlon. He starts by defining the “marginal decade” and how that shapes his training for the events and activities that make up his personal centenarian decathlon. Peter explains how he coaches patients through the challenges of customizing their own list and building out a training plan, including how to set fitness goals early in life in preparation for the marginal decade. From there, he dives into training within the four pillars (zone 2, VO2 max, stability, and strength), including the minimum effective dose, how to split your time, his personal protocols, and other considerations. Additionally, he touches on bone mineral density, female-specific considerations, working through injuries, and the profound impact training can have on the overall quality of life.

We discuss:

The best interventions for longevity [2:15];
The marginal decade and the centenarian decathlon [4:45];
Peter’s personal list of events for his “centenarian decathlon” and how he helps patients create their own list [8:00];
Determining your fitness goals early in life in preparation for the marginal decade, metrics to track, and more [15:00];
How does playing sports like tennis, basketball, or golf fit into training for the centenarian decathlon? [24:15];
Training within the four pillars: minimum effect dose, how to split your time, and other considerations [27:45];
Advice for the older person and why it’s never too late to start [33:45];
Bone mineral density and other female-specific concerns and considerations [36:15];
Training advice for those with minimal access to a gym or equipment [39:30];
Injuries: prevention and working through existing conditions [41:00];
Cardiorespiratory training: how to split time between zone 2 and VO2 max training, and different modalities for a true zone 2 workout [44:15];
VO2 max training: modalities, Peter’s protocol, and how to monitor progress [54:45];
The profound impact training can have on the overall quality of life [58:15]; and
More.

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Cancer screening with full-body MRI scans and a seminar on the field of radiology | Rajpaul Attariwala, M.D., Ph.D. (#61 rebroadcast) Jul 03, 2023

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In this episode, radiologist/engineer, Raj Attariwala, explains how he was able to apply his engineering background to create a unique MRI scanner that is capable of constructing whole-body images with a resolution that is unmatched in the industry. Peter and Raj discuss the implications of such a robust, radiation-free imaging tool on the early detection of cancer. They dive deep into cancer screening and define terms such as sensitivity and specificity that are necessary to really understand this complex space. They then describe the biggest risks involved in this type of screening (false positives) and how Raj’s unique technology and process might drive down this risk substantially. But before that, they discuss all the common imaging technology from X-ray, to CT scan, to PET scans, to ultrasound, to MRI, and more. They touch on the history of each, how they work, the usefulness and limitations of each of them, as well as the varying risks involved such as radiation exposure. If you are interested in cancer screening and/or you’ve ever wondered how any radiology tool works, this episode is for you.

We discuss:

Raj’s road from engineering to radiology [2:45];
How X-ray works, the risk of radiation exposure, and the varying amounts of radiation associated with the different imaging technologies [13:00];
Computed tomography scans (CT scans): The history of CT, how it works, and why we use contrast [22:45];
Ultrasound: Benefits and limitations, and a special use for the heart [36:00];
Detecting breast cancer with mammography: When is works, when you need more testing, and defining ‘sensitivity’ and ‘specificity’ [46:15];
Magnetic resonance imaging (MRI): How it works, defining terms, and looking at the most common types of MRI [59:00];
Brain aneurysms: Using MRI to find them and save lives [1:18:45];
Raj’s unique MRI technology [1:25:15];
The risk of false positives in cancer detection, and how Raj’s MRI can reduce the number of false positives (i.e., increase specificity) [1:38:45];
The unique software Raj created to pair with his MRI machine [1:46:15];
Comparing the radiation exposure of a whole-body PET-CT to Raj’s equipment (DWIBS-MRI) [1:48:45];
How diffusion-weighted magnetic resonance imaging (DW-MRI) has revolutionized cancer screening [1:50:15];
Why a DW-MRI is still not a perfect test [1:54:15];
The potential for advancing MRI technology: Where does Raj think it could improve in the next 5-10 years? [1:58:00];/li>
Are there any commercially available scanners that can match the resolution of Raj’s images? [2:01:00];
Machine learning: When and where might machine learning/AI impact the field of radiology? [2:03:45]; and
More.

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#260 ‒ Men’s Sexual Health: why it matters, what can go wrong, and how to fix it | Mohit Khera, M.D., M.B.A., M.P.H. Jun 26, 2023

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Mohit Khera is a world-renowned urologist with expertise in sexual medicine and testosterone therapy. In this episode, Mohit provides a comprehensive overview of male sexual health. He begins with an in-depth exploration of erectile dysfunction, shedding light on its prevalence across different age groups, diagnostic methods, and its intriguing connection to cardiovascular disease. He then ventures into Peyronie's disease, penile fractures, penile enlargement treatments, prolonged erections, premature ejaculation, and anorgasmia. Shifting gears, Mohit delves into the intricate workings of testosterone, DHT, and estrogen, emphasizing their physiological significance and interplay. He explains blood tests for diagnosing low testosterone, the correlation between symptoms and blood levels in cases of low testosterone, and the pros and cons of different methodologies for increasing testosterone. He concludes with a thought-provoking conversation about the role of testosterone in patients with prostate cancer and addresses concerns surrounding DHT, finasteride, and post-finasteride syndrome.

We discuss:

Mohit’s career path and interest in sexual medicine and infertility [3:00];
The anatomy of the male genitalia [5:45];
The prevalence of sexual dysfunction, its impact on quality of life, and the importance of seeking help [7:15];
Erectile dysfunction (ED): definition, diagnosis, pathophysiology, and more [11:00];
The history of medications to treat ED and the mechanisms of how they work [15:30];
Relationship between aging and erectile dysfunction and Mohit's approach to treating patients and prescribing medications [20:00];
The impact of lifestyle on sexual health and the association between ED and cardiovascular disease [29:30];
Causes and treatments for Peyronie’s Disease, penile fracture, and more [37:30];
The value of ultrasound for ED diagnosis and management strategies [47:45];
Various treatment options for ED: injections, penile prosthesis, and more [50:15];
Priapism (prolonged erection): what is happening and when to seek treatment [57:15];
Shockwave therapy as a treatment for ED [1:02:45];
Stem cell therapy for ED [1:08:15];
Platelet-rich plasma (PRP) injections as a treatment for ED [1:12:00];
Premature ejaculation (PE): prevalence, pathophysiology, and treatment [1:14:45];
Anorgasmia: causes and treatment [1:22:00];
The interplay of sex hormones, the impact of aging, symptoms of low testosterone, and considerations for testosterone replacement therapy (TRT) [1:26:45];
Methods for increasing endogenous testosterone [1:38:45];
Testosterone replacement therapy: various forms of exogenous testosterone, weighing risk vs. reward, and more [1:52:30];
The physiology and purpose of testosterone and DHT, why some men feel fine even with “low” testosterone, personalized approaches to treating low testosterone, and more [2:02:30];
Post-finasteride syndrome [2:09:00];
The role of testosterone in prostate cancer and addressing the notion that TRT could increase risk [2:16:15];
The effects of testosterone as an adjunct to therapy for estrogen-sensitive breast cancer in women [2:27:15];
Resources for those looking for healthcare providers [2:28:45]; and
More.

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#259 - Women's sexual health: Why it matters, what can go wrong, and how to fix it | Sharon Parish, M.D. Jun 19, 2023

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Sharon Parish is a Professor of Medicine in Clinical Medicine and Clinical Psychiatry at Weill Cornell Medical College and a prominent sexual medicine specialist who has been practicing for 30 years. In this episode, Sharon tackles the topic of women's sexual health, including the conditions associated with decreased sexual function and desire and available treatment options. She explores the influence of sexual health on overall well-being while also examining the potential effects of childbirth, birth control, metabolic health, and more on sexual function and desire. Through case studies, Sharon teases apart the differences between desire and arousal, explains the various factors that affect them, and walks through hypothetical treatment plans for the case study patients. In addition, she delves into the subject of menopause, addressing its impact on sexual health as well as the misguided fears around hormone replacement therapy. Stay tuned for next week's launch of our complementary podcast on men's sexual health.

We discuss:

Sharon's interest in sexual medicine and the current state of the field [3:00];
How hormones change in women over time and how that impacts sexual function [8:15];
Changes after childbirth and its impact on sexual function [11:00];
The role of metabolic health and systemic vascular health in sexual health [20:15];
Conditions associated with decreased sexual function and the importance of sexual health for overall wellbeing [26:15];
Sexual dysfunction case study #1: A 41-year-old mother of two, the sexual response cycle, and the difference between arousal and desire [38:45];
Medications that may reduce sexual desire [49:45];
The effect of birth control pills on sexual desire [56:30];
The importance of testosterone in women for sexual function and desire, and why the FDA hasn't approved exogenous testosterone as a therapeutic [1:01:15];
Challenges faced by physicians who are open to prescribing off-label testosterone for women, and Sharon's approach in managing this aspect with her patients [1:14:30];
A hypothetical treatment plan for the patient in case study #1 [1:26:45];
The role of DHEA (a precursor to testosterone) in female sexual health [1:32:15];
Case study #2: A 30-year-old woman with anorgasmia (inability to orgasm) [1:38:30];
Resources for helping women and their partners to enhance the pleasure experienced during sex, overcome anxiety, and increase desire [1:51:30];
Two drugs for premenopausal women with low desire [1:59:30];
Why treatments are potentially underutilized for both desire and genitourinary syndrome of menopause [2:13:15];
Case study #3: A menopausal woman with symptoms [2:19:00];
Addressing the misguided fears around hormone replacement therapy and cancer [2:24:15];
Symptoms and treatment of genitourinary syndrome of menopause [2:32:45];
Age 65 and beyond, and resources for finding a provider [2:37:30]; and
More.

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#258 - AMA #48: Blood pressure—how to measure, manage, and treat high blood pressure Jun 12, 2023

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In this “Ask Me Anything” (AMA) episode, Peter delves into the critical subject of blood pressure, which is one of the three primary causes of atherosclerosis, along with high apoB and smoking. He begins by unraveling the nature of high blood pressure, its prevalence, and why it often goes undiagnosed. Peter describes in detail the proper way to accurately measure blood pressure and what determines a diagnosis. Next, Peter discusses the actionable steps one can take in response to high blood pressure, shedding light on the extent to which factors like weight loss, exercise, and nutrition can make an impact. He also explores the pharmacological options available and offers valuable insights on how to approach them.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #48 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Blood pressure and other risk factors for cardiovascular disease [2:30];
Defining blood pressure and the purpose and meaning of a blood pressure measurement [5:45];
The implications of high blood pressure and the importance of maintaining an optimal level [10:30];
The importance of accurate measurements of blood pressure and how Peter approaches the care of patients at the very top range of “normal” [21:45];
The prevalence of high blood pressure—a hidden epidemic? [24:30];
The consequences of high blood pressure on cardiovascular health, brain health, kidneys, and more [27:45];
Low blood pressure: symptoms and consequences [35:30];
How to properly measure blood pressure [37:45];
Daily variance in blood pressure and the transient changes in blood pressure during exercise [48:00];
Primary hypertension vs. secondary hypertension: what to look for [51:45];
Lifestyle factors impacting blood pressure: weight loss, exercise, and sodium [57:45];
Impact of insulin resistance and type 2 diabetes on blood pressure [1:04:45];
How sleep impacts blood pressure [1:06:45];
Pharmacologic options for managing blood pressure [1:08:00]; and
More.

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#257 ‒ Cognitive decline, neurodegeneration, and head injuries: mitigation and prevention strategies, supplements, and more | Tommy Wood, M.D., Ph.D. Jun 05, 2023

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Tommy Wood is an Assistant Professor of Pediatrics at the University of Washington, where he studies brain injury and how lifestyle choices and environmental factors contribute to brain health, cognitive function, and chronic disease. In this episode, Tommy delves into the complexities of age-related cognitive decline and explores interventions to counteract it. Drawing from his experience working with Formula 1 drivers, he highlights the connection between cognitive function and the right type of demands and training leading to improvement. Next, he explores the various theories on the different types of pathology in dementia and neurodegeneration. He makes the case that a large fraction of dementia is preventable through lifestyle choices and nutrient status, and provides an in-depth overview of interventions and supplements that support cognitive function. Finally, he provides a comprehensive overview of head injuries, including concussions and traumatic brain injuries (TBIs), discussing symptoms, how to mitigate damage following an incident, and long-term management.

We discuss:

Tommy’s professional work, unique skill sets, and interests [3:00];
Age-related decline in cognitive function and memory [5:45];
Improving brain function with the right level and type of demand [20:15];
Formula 1 as a model for how to perform under high cognitive demand and how to increase multitasking capacity [31:30];
Advice for the person reaching middle life looking to mitigate cognitive decline [37:45];
Tasks and activities that support and improve cognitive function [45:30];
Neuropathology of Alzheimer’s disease: exploring the role of amyloid and tau proteins [49:30];
Why Tommy believes dementia research funding should be focused on environmental and lifestyle-based risk factors [1:05:15];
Benefits of lowering homocysteine and boosting omega-3’s, and evidence-based supplements that support cognitive function [1:09:00];
A unifying theory of dementia [1:20:45];
How muscular strength can help with both the prevention and survivability of dementia [1:24:15];
Head injuries: comparing concussions against traumatic brain injuries (TBIs), mitigating the damage after an incident, and the long-term management of head injuries [1:29:15];
Is hyperbaric oxygen treatment helpful after a TBI? [1:45:45];
Supplements that aid recovery from a TBI: creatine, DHA, and choline [1:49:30];
Demands faced by F1 drivers, and testing interventions to improve their performance [1:57:30]; and
More.

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#256 ‒ The endocrine system: exploring thyroid, adrenal, and sex hormones | Peter Attia, M.D. May 29, 2023

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In this special episode of The Drive, Peter provides a comprehensive overview of the various endocrine systems: the thyroid system, the adrenal system, and the sex hormone system (for both men and women). He walks through the basic biology and the feedback cycles that regulate the production of these hormones and discusses the various options for the treatment of hormone deficiencies. In addition, Peter delves into hormone replacement therapy (HRT), providing nuanced insights into its appropriate usage and the clinical approach he adopts when working with patients.

Peter supplements these explanations with whiteboard illustrations. For a more complete understanding, we highly recommend watching these videos over just listening. The videos can be found on our YouTube channel or on the show notes page.

We discuss:

The thyroid system [2:15];
The adrenal system [15:45];
The female sex hormone system [27:00];
The male sex hormone system [40:00]; and
More.

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#255 ‒ Latest therapeutics in CVD, APOE’s role in Alzheimer’s disease and CVD, familial hypercholesterolemia, and more | John Kastelein, M.D., Ph.D. May 22, 2023

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John Kastelein is a renowned expert in lipoprotein metabolism and atherosclerotic cardiovascular disease (ASCVD) research. In this discussion, John delves deep into familial hypercholesterolemia (FH), a genetic disorder characterized by high levels of LDL cholesterol in the blood that increases the risk of developing heart disease. He covers its definition, genetic underpinnings, and clinical identification. He then explores the therapeutic options available for the prevention and treatment of cardiovascular disease, including the captivating history of CETP inhibitors. He explains the past shortcomings of previous CETP inhibitors before underscoring the compelling potential of the latest iterations, not only for cardiovascular disease but also for conditions like Alzheimer's disease and type 2 diabetes. Moreover, he unveils the intricate role of APOE, shedding light on why the APOE4 isoform codes for a protein that significantly increases the risk of Alzheimer's disease and cardiovascular disease. Concluding the discussion, John shares a profound sense of optimism, envisioning the possibility of targeted therapeutic interventions for high-risk patients in the near future.

We discuss:

Familial hypercholesterolemia (FH): a genetic condition [4:30];
Differentiating between phenotype and genotype when it comes to FH [9:45];
The pathophysiology related to mutations of FH [15:30];
Clinical presentations, physical manifestations, and diagnosis of FH [22:00];
Why a small fraction of people with FH do not develop premature ASCVD [34:15];
Treatment and prevention for those with FH [39:45];
Addressing the assertion by some that elevated LDL is not casual in cardiovascular disease [52:45];
The history of CETP inhibitors, and the role of the CETP protein [55:45];
The thrifty gene hypothesis and why genes underlying FH may have been preserved [1:09:00];
The compelling potential of the latest CETP inhibitor (obicetrapib) [1:13:00];
Promising results from phase 3 trials exploring obicetrapib [1:27:45];
Why the APOE4 allele increases the risk of Alzheimer’s disease, and the connection to blood lipids [1:41:30];
The role of APOE in cardiovascular disease [1:51:45];
Takeaways and looking ahead [1:57:00]; and
More.

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#254 - AMA #47: Cold therapy: pros, cons, and its impact on longevity May 15, 2023

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In this “Ask Me Anything” (AMA) episode, Peter delves deep into the data surrounding different forms of cold therapy, including cold water immersion, cryotherapy, and cold showers, aiming to unveil the potential benefits and drawbacks associated with cold therapy. He dissects the studies examining the effects of cold therapy on delayed onset muscle soreness (DOMS), activation of brown adipose tissue, and its potential impact on mood and as a therapeutic approach for depression. Furthermore, Peter discusses the potential negative impact cold therapy may have on muscular hypertrophy and offers his perspective on the extent to which the data support the notion of cold therapy providing longevity benefits. Finally, he also discusses the existing consensus, or lack thereof, regarding the optimal structure of an effective cold therapy protocol.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #47 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Overview of discussion on cold therapy (and a Formula 1 tangent) [1:45];
The most common cold exposure therapies [5:45];
Potential benefits of cold water immersion: a look at the data [9:30];
Comparing the effects of cold water immersion with whole-body cryotherapy [18:30];
The potential impact of cold exposure on mood and as a treatment for depression [20:45];
How do cold showers compare to cold water immersion? [28:15];
Cold exposure and the activation of brown adipose tissue (BAT) [34:15];
Things that clearly impact brain health: smoking, alcohol, sleep, head injuries, blood pressure, and more [34:15];
Exercising in cold temperatures: impact on exercise performance [38:30];
Potential downsides of cold therapy and its impact on hypertrophy, strength, and recovery [44:45];
Are the blunting effects of cold on hypertrophy due to the effects on inflammation? [50:45];
Does cold exposure offer any potential geroprotective benefits? [53:15];
Cold therapy protocols for delayed onset muscle soreness (DOMS) [56:30];
Summarizing the data and takeaways from Peter [1:01:00]; and
More.

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#253 ‒ Hormone replacement therapy and the Women’s Health Initiative: re-examining the results, the link to breast cancer, and weighing the risk vs reward of HRT | JoAnn Manson, M.D. May 08, 2023

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JoAnn Manson is a world-renowned endocrinologist, epidemiologist, and Principal Investigator for the Women’s Health Initiative (WHI). In this episode, she dives deep into the WHI to explain the study design, primary outcome, confounding factors, and nuanced benefits and risks of hormone replacement therapy (HRT). JoAnn reflects on how a misinterpretation of the results, combined with sensationalized headlines regarding an elevated risk of breast cancer, led to a significant shift in the perception and utilization of HRT. From there, they take a closer look at the breast cancer data to separate fact from fiction. Additionally, JoAnn gives her take on how one should weigh the risks and benefits of HRT and concludes with a discussion on how physicians can move towards better HRT practices.

We discuss:

The Women’s Health Initiative: the original goal of the study, hormone formulations used, and potential confounders [4:15];
Study design of the Women’s Health Initiative, primary outcome, and more [16:00];
JoAnn’s personal hypothesis about the ability of hormone replacement therapy to reduce heart disease risk prior to the WHI [26:45];
The relationship between estrogen and breast cancer [30:45];
Why the WHI study was stopped early, and the dramatic change in the perception and use of HRT due to the alleged increase in breast cancer risk [37:30];
What Peter finds most troubling about the mainstream view of HRT and a more nuanced look at the benefits and risks of HRT [45:15];
HRT and bone health [56:00];
The importance of timing when it comes to HRT, the best use cases, and advice on finding a clinician [59:30];
A discussion on the potential impact of HRT on mortality and a thought experiment on a long-duration use of HRT [1:03:15];
Moving toward better HRT practices, and the need for more studies [1:10:00]; and
More.

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#252 ‒ Latest insights on Alzheimer’s disease, cancer, exercise, nutrition, and fasting | Rhonda Patrick, Ph.D. May 01, 2023

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Rhonda Patrick, Ph.D., is a scientist with expertise in the areas of aging, cancer, and nutrition who translates complex scientific topics into actionable insights on her podcast, Found My Fitness. In this episode, Rhonda provides her latest thinking as it relates to Alzheimer's disease including the possibility of a vascular hypothesis as well as the factors that can impact disease risk such as type 2 diabetes, blood pressure, omega supplementation, exercise, sauna, and more. She also touches on cancer risk including the relationship between cancer and exercise as well as the link between alcohol consumption and cancer. Additionally, Rhonda explains her new focus on exercise and protein consumption as well as how her perspective has shifted as it pertains to fasting and time-restricted feeding.

We discuss:

Alzheimer’s disease: Rhonda’s evolved thinking on neurodegenerative diseases [2:30];
The breakdown of the blood-brain barrier in neurodegenerative disease [8:45];
An explanation for the observation that type 2 diabetes increases risk of Alzheimer’s disease [15:45];
The role of omega-3 fatty acids (EPA and DHA) in brain health and prevention of neurodegeneration [19:45];
Comparing the preventable nature of type 2 diabetes, atherosclerosis, cancer, and dementia [32:15];
Blood pressure: an important modifiable lifestyle factor that can affect Alzheimer's disease risk [35:15];
Rhonda’s outlook on “precision medicine” as it pertains to one’s genetic predispositions [38:45];
Possible mechanisms by which exercise reduces the risk of Alzheimer’s disease [45:45];
Building your aerobic pyramid: neurobiological effects of exercise, benefits of lactate peaks, and more [53:45];
Maximizing mitochondrial biogenesis: alternative training approaches and strategies [58:45];
Possible brain benefits of sauna, and Rhonda’s personal protocol [1:09:30];
The relationship between cardiorespiratory fitness and dementia risk [1:15:30];
How exercise may reduce the risk of cancer [1:20:30];
The overarching impact of exercise on health, and the importance of focusing the factors that matter most [1:33:15];
Impact of alcohol consumption on breast cancer risk and overall health [1:37:15];
Exercise as an intervention for poor sleep habits [1:42:30];
The longevity benefits of consuming adequate protein and strength training to preserve muscle mass and strength [1:46:30];
How to get enough of the right kind of protein in your diet [2:05:15];
Fasting: weighing the risk vs. reward [2:12:15];
How Rhonda’s views have shifted on diet and exercise [2:15:30];
How to follow Rhonda’s work and more about the benefits of lactate for the brain [2:21:00]; and
More.

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The impact of stress on our physical and emotional health | Robert Sapolsky, Ph.D. (#51 rebroadcast) Apr 24, 2023

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In this episode, Robert Sapolsky, Ph.D., discusses the widespread impact of stress on our physical and emotional health as well as the mechanisms by which it can precipitate chronic illness, dementia, depression, and more. He also provides insight into the factors that contribute to the stress response (and our ability to handle it) such as social rank, personality, environment, and genetics. Lastly, we discuss how our behavior is altered in the face of stress and how that not only has a pervasive effect on a personal level, but also on society as a whole in how we interact with each other.

We discuss:

Background, interest in stress, and Robert’s time in Kenya studying baboons [2:45];
Physiology of a stress response, and why it’s ingrained in our DNA [9:45];
Individual variation in the response to stress, and how everyone has a different optimal level [19:45];
How social rank and personality differences affect our stress response [26:30];
What’s happening in the brain when faced with stressful situations? [35:00];
What makes the human brain different than all other species? [44:15];
Imprinting stress to your kids epigenetically [48:00];
The role of stress on memory and the consequences of hypercortisolemia [53:00];
The impact of subjective socioeconomic status and social media on stress levels and health [57:45];
Tips for managing stress in the modern world [1:13:15];
What Robert learned about himself studying the social behavior of baboons [1:25:30];
The multilayered factors behind every human behavior, the context of “good and bad”, and exploring the human capacity of the wild extremes of violence and altruism from moment to moment [1:30:15];
PMS: How two women with identical hormone levels can have completely different emotional experiences [1:34:45];
How much of a role do genes play in depression and other emotional states? [1:38:00];
Why is cortisol elevated under sleep deprivation? [1:46:00];
The impact of stress on cancer [1:50:30];
The impact of stress on atherosclerosis, dementia, addiction, and depression [1:57:00];
Impulsiveness, impaired judgment, and lack of empathy in times of stress [2:01:45];
What advice would Robert give his 25-year-old self? [2:08:45]; and
More.

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#251 - AMA #46: Optimizing brain health: Alzheimer's disease risk factors, APOE, prevention strategies, and more Apr 17, 2023

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In this “Ask Me Anything” (AMA) episode, Peter goes into depth on the topic of brain health, starting with how Alzheimer's disease is diagnosed, the significance of blood-based biomarkers in diagnosis, and what the various APOE gene variants mean in terms of a person's risk of developing Alzheimer's disease. Next, Peter discusses the various strategies for preventing Alzheimer's disease and neurodegeneration. He touches briefly on exercise as a potent tool, but focuses more on lesser-known factors that could impact brain health, such as nutrition supplementation, lipid management, brain games, sauna, oral health, hearing loss, and more.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #46 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Diagnosing Alzheimer's disease [2:45];
Biomarkers for Alzheimer’s disease, the C2N test, and other tools for diagnosis [7:30];
Genetic component of Alzheimer’s disease: genes that confer risk [12:45];
Understanding your APOE status and why it’s important to know [17:15];
The prevalence of Alzheimer’s disease and other forms of dementia, and who is at higher risk [21:15];
Can the risk of Alzheimer’s disease be decreased with behavioral changes? [24:15];
Overview of modifiable behaviors that potentially play a role in risk reduction of neurodegeneration [30:15];
Things that clearly impact brain health: smoking, alcohol, sleep, head injuries, blood pressure, and more [34:15];
How nutrition impacts brain health: common diets, metabolic health, energy balance, and more [46:15];
Comparing common diets: data showing the association between the incidence of Alzheimer’s disease and specific diets [59:45];
Supplements: EPA and DHA, vitamin D, and B vitamins [1:13:00];
Supplements: theracurmin, cocoa flavonols, and magnesium L-threonate [1:25:15];
Impact of exercise on brain health, minimum effective dose, and the most important types of exercise [1:33:00];
Challenging the mind with brain games—does it impact neurodegeneration? [1:43:00];
The data on sauna and brain health [1:49:45];
Oral health and its association with brain health [1:52:45];
How reducing lipids can improve brain health and prevent neurodegeneration [1:55:30];
The potential impact of hearing loss on brain health and neurodegeneration [2:04:30]; and
More.

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#250 ‒ Training principles for longevity | Andy Galpin, Ph.D. (PART II) Apr 10, 2023

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Andy Galpin is a Professor of Kinesiology at California State University at Fullerton, where he studies muscle adaptation and applies his research to work with professional athletes. In this episode, Andy returns to the podcast and continues the conversation about training for longevity. He examines the training practices of powerlifters, Olympic weightlifters, Strongmen/women, CrossFit athletes, and sprinters in order to extract insights that can be applied to the individual wanting to optimize for longevity. Andy goes into detail about exercise load and repetition, training volume, the importance of learning proper movement patterns, the advantage of working to technical failure instead of the number of reps, and much more. Andy ties the discussion together by providing a hypothetical training plan for an individual wanting to optimize for longevity and offers advice for avoiding injury.

We discuss:

Review of the function and organization of skeletal muscle [3:15];
Review of muscle fiber types [9:30];
Hypertrophy: changes in muscle fibers and the underlying mechanisms that make a muscle grow [19:30];
Defining sarcoplasmic hypertrophy and how it relates to the number of reps in a set [30:15];
Training for maximum strength: what we can learn from powerlifters and a hypothetical training plan [32:45];
Ideal reps, volume, and load for the powerlifter [44:45];
What should powerlifters do on their off days? [56:45];
Are there consequences of powerlifting on long-term health? [1:02:00];
Defining Olympic weightlifting: a test of power [1:04:30];
Training principles of Olympic weightlifting [1:07:45];
Tracking power output when training [1:17:15];
Frequency of training for Olympic weightlifting [1:22:15];
How post-activation potentiation (and the opposite) can improve power training and speed training [1:24:30];
The Strongman competition: more breadth of movement, strength, and stamina [1:32:00];
Training principles of Strongmen and advice for someone new to the Strongman competition [1:36:45];
CrossFit: a combination of weightlifting movements, endurance, and circuit training [1:50:15];
Learning from elite athletes, heart rate recovery, V02 max, and other metrics [1:58:45];
Optimizing towards being a well-rounded athlete as opposed to a specialist [2:09:45];
What we can learn from the sprinters about speed, acceleration, peak velocity, and technique [2:17:45];
A training plan for the “centenarian athlete” [2:24:30];
Debunking some training and exercise myths [2:33:00];
The “do nots” of training and tips for avoiding injury [2:34:15]; and
More.

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#249 ‒ How the brain works, Andrew’s fascinating backstory, improving scientific literacy, and more | Andrew Huberman, Ph.D. Apr 03, 2023

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Andrew Huberman is a Professor of Neurobiology at Stanford University and host of the Huberman Lab podcast. In this episode, Andrew begins with a fascinating discussion about the brain, including the role of the prefrontal cortex in adjusting your ruleset to match your setting, the neural circuitry underlying the ability of stress to limit creativity and problem-solving, the effect of belief on physiology and performance, and more. He speaks about vision being our “superpower” and compares this to animals that rely more on other senses. Next, he opens up about his personal journey, the struggles and losses he has overcome, the value of therapy, and the many great people who helped him along the way. He speaks to his love of biology and discovery and the importance of staying true to your passion rather than being driven purely by ambition. Lastly, the conversation includes a look to the future of Andrew's scientific work and podcast as well as his unique approach to communicating science and tackling the issue of scientific illiteracy.

We discuss:

Exercise under blood flow restriction, lactate utilization, and transient changes in the brain function in response to adrenaline and stress [3:30];
The role of the prefrontal cortex in governing rulesets [9:15];
New discoveries about the circuitry between the prefrontal cortex, insula, and amygdala, and the insights gleaned about brain function in different emotional states [15:30];
Comparing human vision and other senses to animals [26:00];
A deep dive into vision: evolutionary adaptations, facial recognition, color, and more [39:45];
Sense of smell, pheromones, and why evolution developed better vision over smell [46:30];
The relationship between visual input and time perception [55:30];
Mindset effects: the effect of belief on physiology and performance [1:00:45];
Accessing higher levels of creativity with broadening rulesets and the limiting nature of stress and fear on creativity [1:05:30];
Stress and fear increase autonomic arousal, limit access to rulesets, and inhibit performance [1:12:15];
Andrew’s upbringing, early childhood, and tough adolescent years [1:15:00];
Andrew’s time in a residential treatment program and how he benefited from therapy [1:20:15];
The beginning of positive changes in Andrew’s young life [1:28:30];
Andrew’s decision to turn his life around [1:37:00];
A new passion for science and exercise helps Andrew [1:42:00];
The difference between a postdoc and a PhD [1:54:15];
Staying in touch with the love of biology and not getting pulled into ambition [1:59:15];
Andrew starts his own lab, and continues work to overcome his demons [2:07:00];
The loss of three mentors leads to deep soul searching [2:12:00];
What motivated Andrew to begin his podcast [2:18:00];
Looking to the future of Andrew’s scientific work, podcast, and more [2:22:45];
Andrew’s unique approach to communicating science and the issue of scientific illiteracy [2:30:00]; and
More.

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#248 ‒ OUTLIVE book: A behind-the-scenes look into the writing of this book, motivation, main themes, and more Mar 28, 2023

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After more than six years of research, planning, and writing, Peter’s book, Outlive: The Science and Art of Longevity, is officially available as of March 28th. In this episode, Peter sits down with co-author Bill Gifford to provide a behind-the-scenes look into the writing process, including the motivation for making it happen, how the book evolved over the course of the writing process, and why certain topics were chosen (and omitted). Additionally, they discuss how the book is structured and touch on a few of the book’s main themes to give potential readers an idea of what they can expect.

We discuss:

The meaning of the book’s title and subtitle [3:00];
Finding the right art for the book cover [9:00];
Who is Bill Gifford, and how did he get involved in the book? [16:15];
How Peter’s writing evolved over the six years it took to write this book [25:00];
The structure of the book and what people can expect to learn [29:00];
How the writing of the book and the podcast interviews have shaped Peter’s thinking and approach to translating science [32:45];
Making the book stand the test of time despite the constant evolution of science and medicine [36:00];
Objective, strategy, and tactics [39:30];
Exciting possible progressions in science and medicine over the next decade [42:15];
What is holding back “medicine 3.0” from being the norm? [46:00];
How the book compares to the podcast in terms of technicality and readability for the layman [49:00];
Motivation to write the book and insights into challenges around the writing process [57:15];
Peter’s decision to be the reader for the audiobook [1:10:30];
The many painstaking last-minute changes and edits that brought the book together and made it better [1:19:00];
Peter and Bill’s favorite parts of the book [1:27:30];
The incredible team of people supporting the book [1:31:30]; and
More.

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#247 ‒ Preventing cardiovascular disease: the latest in diagnostic imaging, blood pressure, metabolic health, and more | Ethan Weiss, M.D. Mar 20, 2023

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Ethan Weiss is a preventative cardiologist at UCSF, an entrepreneur-in-residence at Third Rock Ventures, where he is working on a project related to cardiometabolic disease, and a previous guest on The Drive. In this episode, Ethan compares and contrasts the diagnostic imaging tools, CAC (coronary artery calcium score) and CTA (CT angiography), used to image plaque—including the latest in CTA software—and how these tools inform our understanding of ASCVD risk and guide clinical decision-making. Ethan discusses the types of plaque that cause events and the data that make a case for optimal medical therapy over stenting outside of particular cases. He explains why high blood pressure is problematic and walks through the data from clinical trials testing aggressive treatment. He talks about the best way to actually measure blood pressure, why we shouldn’t simply accept that blood pressure rises with age, and how he uses different pharmaceutical agents to treat hypertension. Additionally, Ethan explains our current, but limited, understanding of the role of metabolic health in ASCVD. He discusses the impact of fat storage capacity and the location of fat storage and explains how and why there is still a residual risk, even in people who have seemingly normal lipids, don't smoke, and have normal blood pressure.

We discuss:

Ethan’s entrepreneurial work in the cardiometabolic disease space [4:30];
Calcium scans (CAC scores) and CT angiography (CTA), and how it informs us about ASCVD risk [6:00];
Peter’s historical CAC scores, CTA results, and how one can be misled [10:45];
How Peter’s CTA results prompted him to lower his apoB [14:45];
Calcium scans vs. CT angiogram (CTA) [21:15];
How Ethan makes clinical decisions based on CTA results and plaque burden, and the importance of starting treatment early to prevent ASCVD [28:15];
Improved methods of CTA to grade plaque lesions and how it’s shaped medical decisions such as stenting [33:45];
Why Ethan favors optimal medical therapy over stenting outside of particular situations [41:45];
The need for FFR CTA, and the potential for medical therapy to eliminate ASCVD [54:00];
The fat attenuation index (FAI) and other ways to measure inflammation in a plaque [57:30];
Statins and exercise may increase the risk of calcification, but what does this mean for risk? [59:45];
The root cause of statin hesitation despite evidence that statins are a profoundly important intervention [1:05:30];
Importance of keeping blood pressure in check, defining what’s normal, and whether we should just accept higher blood pressure with age [1:10:45];
Blood pressure variability, how to best measure it, and data suggesting the enormous impact of keeping blood pressure down [1:21:00];
Drugs for treating high blood pressure recommended by the ALLHAT trial [1:35:15];
What the SPRINT trial says about the aggressive treatment of hypertension, and the risks of such treatment [1:38:15];
Confirmatory results in the STEP trial for blood pressure, and how Ethan uses the various pharmacological agents to lower blood pressure in patients [1:43:15];
The role metabolic health in ASCVD: what we do and don’t know [1:51:00];
The impact of fat storage capacity and the location of fat storage on metabolic health and coronary artery disease [1:56:15]; and
More.

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#246 - AMA #45: Pros and cons of GLP-1 weight loss drugs and metformin as a geroprotective agent Mar 13, 2023

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In this “Ask Me Anything” (AMA) episode, Peter focuses the discussion on two topics getting a lot of attention recently. He first dives deep into GLP-1 agonists, most notably semaglutide and tirzepatide, which originally came to market as diabetes drugs but are now being studied and prescribed for weight loss. He walks through the data and compares the effectiveness of the two drugs, the side effects, and perhaps more importantly, his reservations around wide use of these drugs and who he would consider to be a candidate for them. Next, Peter discusses how metformin, another drug originally brought to market for diabetes management, gained popularity as a potential longevity drug even for non-diabetics. Peter gives his take on this possibility and reviews data from a more recent study investigating the question of whether metformin should be used for general “geroprotection.”

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #45 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

The hype around semaglutide, tirzepatide, and other GLP-1 agonists for weight loss [2:30];
Overview of GLP-1 agonists and why these drugs are getting so much attention [6:15];
Defining the term “geroprotective” [13:30];
Semaglutide: background, brand names, indications, and more [15:15];
Tirzepatide: background, brand names, indications, and more [19:15];
How semaglutide and tirzepatide compare in their efficacy in terms of weight loss and other metabolic health metrics [23:45];
Data showing sustained weight loss and improved metabolic metrics with after more than a year of using semaglutide and tirzepatide [29:00];
What happens to body weight when a patient discontinues the medication? [34:45];
Noteworthy side effects of GLP-1 agonists and similar classes of drugs [40:45];
Increased resting heart rate and other concerning trends in patients using GLP-1 agonists [45:15];
Changes in body composition (body fat and lean muscle) in patients on GLP-1 agonists [50:45];
Possible reasons for the loss of lean muscle mass and tips for protecting lean mass [59:00];
GLP-1 agonists and thyroid cancer [1:01:30];
Who might be a candidate for GLP-1 agonists? [1:03:45];
The large financial cost of this class of drugs [1:08:30];
Metformin as a geroprotective drug: origin of the idea that metformin could be a longevity agent even for non-diabetic patients [1:11:30];
A 2022 study on metformin sheds more light on the question of whether metformin should be used for “geroprotection” in non-diabetics [1:21:00];
Peter’s current approach with metformin for his patients [1:25:15]; and
More.

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#245 ‒ Overcoming trauma, finding inner peace, and living a meaningful and fulfilling life | Lewis Howes Mar 06, 2023

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Lewis Howes is a New York Times best-selling author, entrepreneur, speaker, and host of the popular podcast, The School of Greatness. In this episode, Lewis opens up about the various hardships and traumatic events he experienced starting at a very young age and reveals the valuable lessons he learned as he worked through those traumas to improve his emotional health. He talks about how his past hardships likely contributed to his success in business and athletics, only to leave him feeling unsatisfied and unfulfilled. Next, he discusses how many aspects of his life were suffering, the inflection point that drove Lewis to seek help, and the long but beautiful healing journey that followed. Lewis makes the case that adversity, and even trauma, can be beneficial if one finds meaning in tribulations and has the courage to face one’s fears and insecurities. Finally, Lewis shares the many modalities of therapy that helped him along the way and gives advice for those wanting to find inner peace and live a fulfilling, rich, abundant, joyful life.

We discuss:

Lewis’s upbringing and the impact of his older brother going to prison [2:45];
Finding lessons in tragedy and adversity [10:45];
Lasting trauma from being sexually abused at age 5 [13:15];
Inflection point that drove Lewis to seek help, and a beautiful experience at a therapeutic workshop [16:45];
A powerful workshop on emotional intelligence jump started Lewis’s healing journey [27:30];
How being authentic can strengthen bonds with family and bring inner peace [39:30];
Comparing adversity with trauma and finding meaning in struggle [45:15];
Association between adverse childhood events and diseases in adulthood [56:15];
How addressing his issues with intimate relationships helped Lewis overcome physical pain related to his past trauma [59:15];
Healing is a journey that takes time and requires courage to face your fears and insecurities [1:08:45];
How Lewis thinks about mortality and uses it as motivation to pursue his dreams [1:13:00];
How anyone can benefit from therapy or coaching, and Lewis’s advice for finding inner peace [1:22:45];
Lewis’s newest book, The Greatness Mindset [1:29:15]; and
More.

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#244 ‒ The history of the cell, cell therapy, gene therapy, and more | Siddhartha Mukherjee Feb 27, 2023

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Siddhartha Mukherjee is an oncologist, Pulitzer Prize-winning author, and previous guest on The Drive. In this episode, Sid discusses many of the subjects of his latest book, The Song of the Cell, including the incredible discovery of the cell and how it transformed medicine. He explains the evolutionary drive to go from single-cell to multicellular life and unpacks the four different types of cell-based therapies and the problems they are attempting to solve. He also provides the latest in gene therapy, such as CRISPR, and the ethical questions around human gene editing. Additionally, he touches on a number of fascinating topics, such as the challenges of medical science, the human brain, learning styles, his writing process, mental health, and more.

We discuss:

How the cell brings the genome to life, and how Sid’s recent book fits into his prior work to tell a story [2:30];
How the germ theory of disease and an understanding of the cell fueled a big leap in medicine [9:45];
What is the evolutionary drive for multicellular life? [17:15];
Four types of cell therapies and the challenges of gene therapy [26:00];
CAR T-cell therapy: promising gene therapy for cancer [36:30];
The possibility of using gene therapy to treat germline mutations like sickle cell disease [41:45];
The incredible revolution of gene editing with CRISPR [45:15];
Ethical questions around human gene editing [52:30];
The complex role of genetics in mental illness [1:01:30];
Two types of problems in science: the “eye in the sandstorm” problem and the “sand in the eye” problem [1:06:15];
Understanding neural networks: an example of the “sand in the eye” problem being solved [1:08:45];
Importance of learning by doing: comparing the learning styles of a doctoral student to a medical student [1:16:30];
Sid’s unique and brilliant style of writing [1:20:45];
Falling as the leading cause of accidental death: a liability of multicellular existence [1:25:00];
Sid’s struggle with depression and his desire to change the stigma around mental illness [1:29:15]; and
More.

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#243 ‒ The fentanyl crisis and why everyone should be paying attention | Anthony Hipolito Feb 20, 2023

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Anthony Hipolito is a sheriff’s deputy in Hays County, Texas with over 24 years of experience in law enforcement. In this episode, Anthony discusses his work to spread awareness about illicit fentanyl use and the drastic increase in accidental overdoses, especially in young people. Anthony explains the deadly nature of fentanyl, including how many counterfeit drugs are now being laced with deadly doses of fentanyl. He breaks down how fentanyl is being brought to the US and how younger and younger kids are being targeted. Additionally, Anthony discusses his goal of spreading awareness to our communities and provides important advice for what parents can do.

We discuss:

Anthony’s life of service in law enforcement [5:30];
Fentanyl: medical use, recreational use, and the recent rise in prevalence [8:30];
The story of a teenager dying from an accidental overdose of fentanyl [16:30];
The scope of deaths being caused by accidental overdoses (the majority of which are from fentanyl) [23:00];
How young kids are being targeted, and how fentanyl makes it across our borders and gets distributed [28:30];
What happens to a person when they overdose [35:30];
Whether laws around drug possession are helping or hurting, and the need to focus on helping people that feel the need to take these counterfeit drugs [37:00];
How fentanyl is being added to all kinds of drugs that you wouldn’t expect [42:45];
What can we do as parents? [47:15];
Narcan: a treatment for opioid overdoses [50:15];
Importance of awareness, having conversations with kids early in life, and other key takeaways for parents [56:30]; and
More.

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#242 - AMA #44: Peter’s historical changes in body composition with his evolving dietary, fasting, and training protocols Feb 13, 2023

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In this “Ask Me Anything” (AMA) episode, Peter reviews the last 12+ years of his DEXA scan results revealing the changes to his body composition, lean muscle mass, visceral adipose tissue, and more. He explains how his body composition and blood biomarkers were impacted by the various dietary approaches (ketosis, fasting, high protein, etc.) and training protocols (primarily endurance, primarily strength training, etc.) he has undertaken over the years. Furthermore, Peter explains his planned approach moving forward following his most recent DEXA scan in late 2022.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #44 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

DEXA scans and other methods for tracking body composition [2:30];
Importance of tracking data over time to see trends [10:15];
DEXA scans in 2011: swimming, lifting, and a carb-restricted diet [12:45];
DEXA scans 2012-2014 during Peter’s time on a strict ketogenic diet [18:30];
Blood biomarkers for evaluating metabolic health [25:15];
DEXA scan in 2020 after several years of regularly engaging in time-restricted feeding and prolonged fasting protocols [28:45];
DEXA scan in 2021: shifting focus to adding muscle, high-protein diet, and more strength training [40:00];
DEXA scan in early 2022: eating additional calories and adding blood flow restriction (BFR) to his workouts [44:45];
DEXA scan in late 2022: a dramatic change following shoulder surgery, and the impact of stress [48:30];
Peter’s approach moving forward following his most recent DEXA scan [59:15];
A rundown of the various nutritional methods of energy restriction [1:06:15];
Current thoughts on fasting and key takeaways [1:09:45]; and
More.

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#241 ‒ Living intentionally, valuing time, prioritizing relationships, and more keys to a rich life | Ric Elias (Part 2) Feb 06, 2023

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Ric Elias, the founder of Red Ventures and previous guest on The Drive, returns to discuss his evolving insights on time, relationships, parenting, and how to make the most of the gift of life. In this episode, he reflects on the changes he’s made since his near-death experience during the crash landing of Flight 1549 on the Hudson River in 2009. Ric reveals many keys to living a rich life, such as aiming for continuous growth, approaching life with true intentionality, and valuing our time in accordance with that. He talks about relationships as the core of a rich life and provides insights on parenting and how we should think about our relationship with our kids as they grow older. Finally, Ric discusses the importance of staying true to yourself, the value in struggle, and finding meaning in helping others.

We discuss:

Reflecting on the tumultuous last few years and how his experience on Flight 1549 helped him [2:30];
Parenting: a game of tug of war that you must ultimately lose [5:00];
Importance of friendship and Ric’s motivation for his recent “Friends summit” [8:00];
The impact of looking forward and focusing on growth on finishing life well [13:00];
How our relationships with our children evolve as they grow, and a new perspective on purpose [21:15];
Living with complete intention for a rich life, valuing your time, and other life lessons inspired by Ric’s near-death experience on Flight 1549 [31:15];
How society’s relationship with work has changed, the pros and cons of remote and hybrid working environments, and an update on his company “Red Ventures” [37:45];
Ric’s dedication to philanthropy [44:45];
The Golden Door Scholars program aiming to help undocumented students with education and a future career [50:30];
Ric’s journey in health and longevity [59:15];
Letting go of guilt and loving yourself [1:02:30];
The relationship between happiness and wealth [1:06:45];
Playing the “infinite game,” staying true to oneself, and ignoring the negative [1:09:15];
Speculating on the meaning of success, the drivers of greatness, and the value of struggle [1:16:00]; and
More.

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#240 ‒ The confusion around HDL and its link to cardiovascular disease | Dan Rader, M.D. Jan 30, 2023

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Dan Rader is a Professor at the Perelman School of Medicine at the University of Pennsylvania, where he conducts translational research on lipoprotein metabolism and atherosclerosis with a particular focus on the function of high-density lipoproteins (HDLs). In this episode, Dan goes in-depth on HDL biology, including the genesis of HDL, its metabolism, function, and how this relates to atherosclerotic cardiovascular disease (ASCVD). He explains why having high HDL-C levels does not directly translate to a low risk of cardiovascular disease and reveals research pointing to a better way to measure the functionality of HDL and predict disease risk. He also goes into detail on the role of HDL in reverse cholesterol transport and the benefits this has for reducing ASCVD. Additionally, Dan discusses the latest thinking around the association between HDL cholesterol and neurodegenerative diseases and ends the conversation with a discussion of how the latest research on HDL provides a promising outlook for ongoing trials and future therapeutic interventions.

We discuss:

The lipidology of apoB and apoA [4:00];
A primer on the high-density lipoprotein (HDL): genesis, structure, and more [9:30];
How the lipoprotein system differs in humans compared to other mammals [20:00];
Clarifying the terminology around HDL and apoA [25:30];
HDL metabolism [31:45];
CETP inhibitors for raising HDL-C: does it reduce CVD risk? [34:45];
Why it’s so important to have hard outcome trials in the field of cardiovascular medicine [42:30];
SR-B1: an HDL receptor important for cholesterol efflux [48:00];
The association between HDL levels and atherosclerosis: are they causally linked? [53:15];
How insulin resistance is impacting HDL, and how HDL-C provides insights into triglyceride metabolism [58:00];
Disappointing results from the studies of niacin—a drug that raises HDL-C and lowers apoB [1:08:15];
HDL lipidation, dilapidation, and reverse cholesterol transport [1:12:00];
Measuring the cholesterol efflux capacity of HDL: a better predictor of ASCVD risk than HDL-C? [1:22:00];
A promising new intervention that may promote cholesterol efflux and reverse cholesterol transport [1:32:45];
The association between HDL cholesterol and neurodegenerative diseases [1:34:00];
Challenges ahead, a promising outlook, and the next frontier in lipidology [1:44:45]; and
More.

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#239 ‒ The science of strength, muscle, and training for longevity | Andy Galpin, Ph.D. (PART I) Jan 23, 2023

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Andy Galpin is a Professor of Kinesiology at California State University at Fullerton, where he studies muscle adaptation and applies his research to work with professional athletes. In this episode, Andy sets the foundation for the conversation by discussing the anatomy, microanatomy, and physiology of the muscle, including explaining what it actually means to undergo hypertrophy of the muscle. He then explains the difference between power, strength, speed, and hypertrophy and how those differences relate to what's happening at the cellular level and the functional unit level. Additionally, he discusses energy sources for muscles, the importance of protein for muscle synthesis, the various types of muscle fibers, and the factors that determine one’s makeup of muscle fibers. Finally, Andy wraps the conversation with how he would design a program for an untrained person committed to adding muscle and functional strength for longevity.

We discuss:

Andy’s path to expertise in exercise [3:30];
Contrasting strength, power, and force production and how they inform us about training for longevity [9:30];
Muscle energetics: Fuels that provide energy to muscles, and the importance of protein [17:45];
The structure and microanatomy of muscle, muscle fibers, and more [29:30];
Energy demands of skeletal muscle compared to other tissues in the body [39:45];
How a muscle contraction works and why it requires ATP [48:00];
Muscle fibers: modulation between fiber types with movement and changes in fibers with training and aging [53:15];
Andy’s study of twins demonstrating the difference in muscle fibers between a trained and untrained individual [1:02:30];
Microanatomy of fast-twitch and slow-twitch muscle fibers [1:11:15];
Factors that determine one’s makeup of muscle fibers and how adaptable they are with training [1:22:15];
Hypertrophy and what happens at the cellular level when a muscle grows [1:30:00];
How athletes quickly cut water weight and the rehydration process [1:37:30];
Different types of athletes [1:47:30];
Training advice for a hypothetical client who’s untrained and wants to add muscle and functional strength for longevity [1:49:45];
Changes in muscle and muscular function that occur with aging [1:53:45];
Training plan for the hypothetical client [1:59:30];
What drives muscle hypertrophy? [2:12:15];
How to properly incorporate isometric exercises into a workout [2:19:00];
Additional training tips: movement patterns, how to finish a workout, and more [2:25:45];
Ways to incorporate high heart rate exercise into a workout plan [2:28:45]; and
More.

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#238 – AMA #43: Understanding apoB, LDL-C, Lp(a), and insulin as risk factors for cardiovascular disease Jan 16, 2023

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In this “Ask Me Anything” (AMA) episode, Peter answers questions related to the leading cause of death in both men and women—atherosclerotic cardiovascular disease (ASCVD). He highlights the most important risk factors for ASCVD, such as apoB, LDL, hyperinsulinemia, and Lp(a), and explains the mechanism by which they confer risk and how these factors are interrelated. Peter also dives deep into the data around apoB to try to answer the question of how much residual risk is conferred for ASCVD through metabolic dysfunction once you correct for apoB. He also looks at the data around lifetime risk reduction of ASCVD in the context of low apoB.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #42 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

A racecar analogy for understanding atherosclerotic cardiovascular disease [2:00];
Defining and differentiating apoB and LDL-C [10:00];
The interrelated nature of insulin levels, apoB, triglycerides, and ASCVD parameters [13:00];
Another way that hyperinsulinemia plays a role in endothelial dysfunction [18:00];
Why Peter uses the oral glucose tolerance test (OGTT) with all patients [20:15];
Is there any evidence that hyperinsulinemia is an independent contributor to ASCVD? [23:00];
Thinking through risk in the context of high-fat diets resulting in improved metabolic metrics but with an elevation of apoB/LDL-C [27:30];
Thinking through risk in the context of low apoB but higher than normal triglyceride levels [32:15];
The importance of lowering apoB for reducing ASCVD risk [38:15];
Data on men and women with familial hypercholesterolemia that demonstrates the direct impact of high apoB and LDL-C on ASCVD risk [47:45];
Importance of starting prevention early, calcium scores, and explaining causality [52:30];
Defining Lp(a), its impact on ASCVD risk, and what you should know if you have high Lp(a) [56:30];
Lp(a) and ethnic differences in risk [1:00:30];
Why someone with elevated Lp(a) should consider being more aggressive with apoB lowering strategies [1:05:00];
Addressing the common feeling of hesitancy to taking a pharmacologic approach to lower ASCVD risk [1:07:15];
Peter’s take on the 2022 Formula 1 season and thoughts on 2023 [1:15:15]; and
More.

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#237 ‒ Optimizing life for maximum fulfillment | Bill Perkins Jan 09, 2023

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Bill Perkins is one of the world’s most successful hedge fund managers and entrepreneurs, and the author of the bestseller, Die With Zero. In this episode, Bill unpacks the Die With Zero philosophy which challenges conventional thinking related to the balance between health, wealth, and time—the three variables important for fulfillment. Bill makes the case that we should strive for maximum net fulfillment rather than net worth (or even health). He argues that we need to optimize our life to have memorable experiences before it’s too late and that most people are over-saving and under-living. Bill also explains how one can apply the principles in Die With Zero to break out of “autopilot” and optimize their life to achieve maximum net fulfillment.

We discuss:

Bill’s upbringing, background, and first job on Wall Street [3:15];
A missed experience and feeling of regret that shaped Bill’s thinking [14:15];
Thinking in terms of time, and the relationship between money, time, and health [17:00];
Solving for net fulfillment and allocating your time based on the seasons of life [27:15];
How Bill thinks about risk, opportunity costs, and the difference between fear and risk tolerance [35:30];
Optimizing for fulfillment, finding purpose outside of work, and more [41:45];
Thinking about the order of experiences you want to have based on seasons of life [50:00];
Bill’s unique perspective on philanthropy and a more impactful way to give money away [54:45];
Applying the principles in ‘Die With Zero’ to maximize fulfillment [1:04:00];
How to break out of living life on autopilot [1:14:30];
When should your net worth peak? [1:18:00];
Taking calculated risks [1:21:30];
Bill shares a lesson from his incredible birthday [1:25:15];
How Bill’s philosophy has evolved since writing Die With Zero [1:34:00]; and
More.

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#236 ‒ Neurodegenerative disease: pathology, screening, and prevention | Kellyann Niotis, M.D. Jan 02, 2023

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Kellyann Niotis is a neurologist specializing in risk reduction strategies for the prevention or slowing of neurodegenerative disorders. In this episode, Kellyann provides an overview of the various diseases associated with neurodegeneration, including, but not limited to, Alzheimer’s disease, Lewy body dementia, and Parkinson’s disease. She goes in-depth on Parkinson’s disease, explaining its pathology, role in movement capacity, very early warning signs, and the role of anxiety and sleep. Similarly, she provides an in-depth discussion of Alzheimer’s disease, including the latest in screening, genetics, and tools/strategies for prevention. She ties the discussion together by explaining the differences and commonalities among the various diseases of neurodegeneration and the potential causative triggers, and she highlights the importance of early screening, cognitive testing, and taking the proper steps to lowering the risk of disease.

We discuss:

Kellyann’s background, training, and interest in the brain [2:30];
A primer on neurodegeneration: different types, prevalences, interventions, and more [5:30];
Overview of Parkinson’s disease and neuromuscular disorders including ALS [16:00];
Parkinson’s disease: early signs, diagnosis, genetics, causative triggers, and more [17:30];
Interventions to delay or avoid Parkinson’s disease, and the role of sleep and anxiety [31:15];
The challenge of standardizing early interventions for Parkinson’s disease without a clear biomarker [39:45];
Alzheimer’s disease: pathophysiology and the role of the amyloid and tau proteins [47:45];
Can PET scans be informative for diagnosing Alzheimer’s disease? [51:15];
Tau accumulation in the brain, tau scans, serum biomarkers, and possible early detection of Alzheimer’s disease pathology [57:00];
Cognitive testing explained [1:03:30];
The challenge of identifying the stage of the disease and why drugs have not shown efficacy [1:14:45];
The association between hearing loss and dementia [1:17:45];
The relationship between oral health and neurodegenerative diseases [1:21:30];
Genetic risk for Alzheimer’s disease [1:24:45];
What one’s mitochondrial haplotype can reveal about their risk of neurodegenerative disease [1:32:30];
The positive impact of exercise on brain health [1:37:00];
High blood pressure as a risk factor [1:40:00];
Why women are disproportionately affected by Alzheimer’s disease [1:44:15];
Final takeaways: the future of understanding neurodegenerative disease and further reducing risk [1:46:45]; and
More.

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James Clear: Building & Changing Habits (#183 rebroadcast) Dec 26, 2022

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James Clear is the author of the New York Times bestseller Atomic Habits. His extensive research into human behavior has helped him identify key components of habit formation and develop the “Four Laws of Behavioral Change.” In this episode, James provides insights into how both good and bad habits are formed, including the influence of genetics, environment, social circles, and more. He points to changes one can make to cultivate more perseverance and discipline and describes the profound impact habits can have when tying them into one’s self-identity. Finally, James breaks down his “Four Laws of Behavioral Change” and how to use them to create new habits, undo bad habits, and make meaningful changes in one’s life.

We discuss:

Why James became deeply interested in habits [1:45];
Viewing habits through an evolutionary lens [6:00];
The power of immediate feedback for behavior change, and why we tend to repeat bad habits [9:15];
The role of genetics and innate predispositions in determining one’s work ethic and success in a given discipline [14:30];
How finding one’s passion can cultivate perseverance and discipline [23:15];
Advantages of creating systems and not just setting goals [29:15];
The power of habits combined with self-identity to induce change [36:30];
How a big environmental change or life event can bring on radical behavioral change [50:30];
The influence of one’s social environment on their habits [54:15];
How and why habits are formed [1:00:30];
How to make or break a habit with the “Four Laws of Behavior Change” [1:09:30];
Practical tips for successful behavioral change—the best strategies when starting out [1:16:15];
Self-forgiveness and getting back on track immediately after slipping up [1:30:30];
Law #1: Make it obvious—Strategies for identifying and creating cues to make and break habits [1:39:45];
Law #2: Make it attractive—examples of ways to make a new behavior more attractive [1:47:45];
Law #3: Make it easy—the 2-minute rule [1:58:45];
Law #4: Make it satisfying—rewards and reinforcement [2:03:30];
Advice for helping others to make behavioral changes [2:06:00]; and
More.

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#235 ‒ Training principles for mass and strength, changing views on nutrition, creatine supplementation, and more | Layne Norton, Ph.D. Dec 19, 2022

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Layne Norton holds a Ph.D. in nutritional sciences and is a physique coach, natural bodybuilder and powerlifter, and two-time previous podcast guest. In this episode, Layne discusses his training as a powerlifter and shares training principles that non-powerlifters can apply to improve muscle strength and mass. Layne goes in-depth on creatine supplementation, including the benefits for lean mass and strength, and addresses the common arguments against its regular usage. Additionally, Layne touches on many areas of nutrition, including how his opinions have changed on certain topics. Layne also touches on the subjects of protein, fiber, and fat in the diet, as well as the different tools and dietary approaches for energy restriction.

We discuss:

The sport of powerlifting and Layne’s approach during competitions [2:30];
Training for strength: advice for beginners and non-powerlifters [13:15];
Low-rep training, compound movements, and more tips for the average person [23:15];
How strength training supports longevity and quality of life: bone density, balance, and more [28:15];
Peak capacity for strength as a person ages and variations in men and women [33:00];
Effects of testosterone (endogenous and exogenous) on muscle gain in the short- and long-term [36:45];
How Layne is prepping for his upcoming IPF World Masters Powerlifting competition [44:00];
Creatine supplementation [54:30];
How important is rep speed and time under tension? [1:05:30];
Validity of super slow rep protocols, and the overall importance of doing any exercise [1:12:45];
Navigating social media: advice for judging the quality of information from “experts” online [1:23:00];
Layne’s views on low-carb diets, the tribal nature of nutrition, and the importance of being able to change opinions [1:34:45];
Where Layne has changed his views: LDL cholesterol, branched-chain amino acid supplementation, intermittent fasting, and more [1:42:00];
The carnivore diet, elimination diets, and fruits and vegetables [1:55:15];
Fiber: Layne’s approach to fiber intake, sources of fiber, benefits, and more [2:00:15];
Confusion around omega-6 polyunsaturated fatty acids and the Minnesota Coronary Experiment [2:05:00];
Layne’s views on fats in the diet [2:13:00];
Flexible dieting, calorie tracking, and the benefits of tracking what you eat to understand your baseline [2:18:00];
The nutritional demands of preparing for a bodybuilding show [2:30:45];
The psychological effects of aging and changes to one’s identity [2:42:00]; and
More.

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#234 ‒ Chris Hemsworth on Limitless, longevity, and happiness Dec 12, 2022

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Chris Hemsworth, best known for his role as Thor in the Marvel movies, joins Peter to discuss his recent work in the docuseries called Limitless. In the docuseries, Chris undertook extreme challenges to explore his physical and emotional limits and gain insights into longevity. In this episode, Chris discusses these many challenges—from fasting to arctic swims to 100-foot rope climbs—as well as the insights that he gained from each. Peter, who also played a role in the docuseries, guides Chris through the science of longevity, including what Chris’s APOE-ε4 genotype means for his risk of Alzheimer’s disease. Additionally, Chris describes how his outlook on health, happiness, work-life balance, and more have changed from his experience on Limitless.

We discuss:

Limitless: how Chris got involved and his overall experience filming the docuseries [3:00];
“Fasting” ‒ ep. 3 of Limitless in which Chris attempts a 4-day fast [8:15];
“Shock” ‒ ep. 2 of Limitless in which Chris swims in the Arctic Ocean [12:15];
Cold exposure: the potential physical and mental benefits [19:30];
“Strength” ‒ ep. 4 of Limitless in which Chris explores how muscle can improve longevity [21:15];
The APOE-ε4 genotype and Alzheimer’s disease risk [31:30];
How Chris uses sauna [39:45];
“Acceptance” - ep. 6 of Limitless in which Chris explores the meaning of life by contemplating death [42:15];
Chris’s new perspective on work-life balance [52:00];
“Stress-Proof” - ep. 1 of Limitless in which Chris learns about the impact of stress and how to manage it [54:30];
Chris reflects on his intrinsic motivation driven by both fear and purpose [58:00];
Chris reflects on his career arc and how his presence as an actor has evolved [1:01:15];
How Chris’s outlook has changed since filming Limitless [1:05:00]; and
More.

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#233 - AMA #42: Optimizing sleep - bedtime routine, molecule regimen, sleep trackers, sauna, & more Dec 05, 2022

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In this “Ask Me Anything” (AMA) episode, Peter answers a number of questions on optimizing sleep. He describes his pre-bedtime routine, how he utilizes a sauna, and his current regimen of medicines and supplements for improving sleep time and quality. He goes in depth on each of the molecules that have shown promise in boosting sleep, including their mechanisms of action as well as any noteworthy contraindications. Peter also discusses sleep wearables, including both the positives and potential negatives of using such trackers, and much more.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #42 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Peter’s current pre-bedtime routine [3:30];
Sauna: Peter’s routine, sleep benefits, and tradeoffs [10:45];
Importance of keeping an open mind as new information arrives [16:15];
Importance of reducing stimulation leading up to bedtime [19:30];
Medications that can enhance sleep: mechanisms of action, contraindications, risks, and Peter’s regimen [20:30];
Why medications can enhance sleep, but should not replace good sleep habits [34:45];
Sleep supplements: mechanisms of action, contraindications, and Peter’s regimen [37:30];
Temperature during sleep, cooling devices, mattresses, and more [53:00];
A tip to help avoid straining your back in the morning [59:15];
Contrasting polysomnography with wearable sleep trackers [1:00:45];
Sleep tracking wearables: interpreting metrics, and the pros and cons of trackers [1:04:30];
Final takeaways on sleep [1:16:30]; and
More.

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#232 ‒ Shoulder, elbow, wrist, and hand: diagnosis, treatment, and surgery of the upper extremities | Alton Barron, M.D. Nov 28, 2022

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Alton Barron is an orthopedic surgeon specializing in the shoulder, elbow, and hand. In this episode, Alton breaks down the anatomy of the upper extremities and discusses the most common injuries associated with this area of the body. He explains in detail how he examines the shoulder, elbow, and hand to find the source of the pain and lays out the non-surgical and surgical treatment options as well as the factors that determine whether surgery is appropriate. Additionally, Alton describes the surgical procedures that, when done appropriately, can lead to tremendous reduction of pain and improvement in function.

We discuss:

Alton’s path to orthopedic surgery [3:45];
Evolution of orthopedics and recent advances [8:45];
Anatomy of the upper extremities [13:30];
Rotator cuff injuries, shoulder joint dislocation, and more [21:15];
Peter’s shoulder problems [31:30];
The structure of the biceps and common injuries [35:30];
Labrum tears in the shoulder and natural loss of cartilage with usage and time [38:15];
Shoulder evaluation with MRI vs. physical exam, diagnosing pain, and when to have surgery [41:30];
How anatomical variation can predispose one to injury and how screening may help [50:30];
Pain generators in the shoulder, and the important nuance of the physical exam [56:00];
Frozen shoulder [1:05:15];
Shoulder pain that originates in the neck [1:11:15];
Surgical treatments for a labral tear, and factors that determine whether surgery is appropriate [1:16:00];
Repairing the rotator cuff [1:29:15];
Are platelet-rich plasma (PRP) injections or stem cells beneficial for healing tears? [1:38:15];
Repair of an AC joint separation [1:45:15];
Total shoulder replacement [1:55:45];
The elbow: anatomy, pain points, common injuries, treatments, and more [2:05:30];
How Tommy John surgery revolutionized Major League Baseball [2:17:15];
History of hand surgery and the most significant advancements [2:22:15];
The hand: anatomy, common injuries, and surgeries of the hand and wrist [2:29:30];
Carpal tunnel syndrome [2:40:00];
Other common injuries of the hand and forearm [2:47:15];
Grip strength [2:55:15];
Arthritis in the hands [2:59:30];
Trigger finger [3:07:45];
Nerve pain, numbness, and weakness in the upper limbs [3:14:00];
The Musician Treatment Foundation [3:22:00];
Gratitude and rucking [3:34:15]; and
More.

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A masterclass on insulin resistance—mechanisms and implications | Gerald Shulman, M.D., Ph.D. (#140 rebroadcast) Nov 21, 2022

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Gerald Shulman is a Professor of Medicine, Cellular & Molecular Physiology, and the Director of the Diabetes Research Center at Yale. His pioneering work on the use of advanced technologies to analyze metabolic flux within cells has greatly contributed to the understanding of insulin resistance and type 2 diabetes. In this episode, Gerald clarifies what insulin resistance means as it relates to the muscle and the liver, and the evolutionary reason for its existence. He goes into depth on mechanisms that lead to and resolve insulin resistance, like the role of diet, exercise, and pharmacological agents. As a bonus, Gerald concludes with insights into Metformin’s mechanism of action and its suitability as a longevity agent.

We discuss:

Gerald’s background and interest in metabolism and insulin resistance (2:30);
Insulin resistance as a root cause of chronic disease (6:30);
How Gerald uses NMR to see inside cells (10:00);
Defining and diagnosing insulin resistance and type 2 diabetes (17:15);
The role of lipids in insulin resistance (29:15);
Confirmation of glucose transport as the root problem in lipid-induced insulin resistance (38:15);
The role of exercise in protecting against insulin resistance and fatty liver (48:00);
Insulin resistance in the liver (1:05:00);
The evolutionary explanation for insulin resistance—an important tool for surviving starvation (1:15:15);
The critical role of gluconeogenesis, and how it’s regulated by insulin (1:20:30);
Inflammation and body fat as contributing factors to insulin resistance (1:30:15);
Treatment approaches for fatty liver and insulin resistance, and an exciting new pharmacological approach (1:39:15);
Metformin’s mechanism of action and its suitability as a longevity agent (1:56:15); and
More.

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#231 - AMA #41: Medicine 3.0, developments in the field of aging, healthy habits in times of stress, and more Nov 14, 2022

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In this “Ask Me Anything” (AMA) episode, Peter answers a wide variety of questions, starting with a discussion on the evolution of medicine and the hopeful transition to “Medicine 3.0.” Peter recounts his unique career path and explains how he assesses risk and utilizes frameworks for decision-making. He also describes how he prioritizes his health while navigating the stresses of life, and he reviews the most exciting developments in the aging and longevity space. He finishes with some rapid-fire questions on cold plunging, strategies for lowering apoB levels, designing an exercise program for beginners, and more.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #41 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

The evolution of medicine and the transition to “Medicine 3.0” [3:00];
Peter’s unorthodox career arc and what led him to this point [11:45];
What does Peter consider to be his superpowers? [22:15];
How Peter thinks about risk and explains it to his patients when making medical decisions [26:45];
The advantage of using frameworks for decision-making [37:00];
What advice would Peter give his 30-year old self? [42:15];
Why longevity is such a hard problem to solve [42:30];
The most impactful developments in the field of longevity and aging in the last 5 to 10 years [46:15];
What is Peter most excited to see develop in the health and longevity space in the next few years? [51:30];
Prioritizing healthy habits while navigating the stresses of life and time constraints [53:45];
How Peter navigates periods of high stress [58:00];
What fitness watch did Peter recently purchase? [1:03:45];
Potential benefits of cold plunging [1:05:15];
Advice for someone beginning an exercise program [1:07:30];
Strategies and tactics to lower apoB levels [1:09:00];
Interesting studies and books Peter has recently read [1:11:30]; and
More.

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#230 ‒ Cardiovascular disease in women: prevention, risk factors, lipids, and more | Erin Michos, M.D. Nov 07, 2022

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Erin Michos is an internationally-known leader in preventive cardiology and women’s cardiovascular health. In this episode, Erin discusses current trends in cardiovascular disease (CVD) through the lens of female biology and the observation that major adverse cardiac events in both sexes are on the rise. She walks through risk factors including LDL-cholesterol, apoB, and Lp(a) and makes the case for the importance of early preventative measures. She explains various interventions for reducing risk including a discussion of statins, GLP-1 agonists, PCSK9-inhibitors, and drugs that lower Lp(a). She goes in-depth on female-specific factors that contribute to CVD risk such as pregnancy, grand multiparity (having five or more children), oral contraceptives, menopause, and polycystic ovary syndrome (PCOS). Additionally, she explains her approach with patients as it relates to the use of hormone replacement therapy and provides advice for people wanting to lower risk both through lifestyle changes and medications.

We discuss:

Erin’s background in preventive cardiology and women’s health [2:30];
Recent trends in cardiovascular disease in women, mortality data, and how it compares to cancer [5:15];
Why early preventative measures are critical for cardiovascular disease risk [13:15];
ApoB as a causal agent of CVD, and why high apoB levels are not being aggressively treated in most cases [19:45];
The rising trend of metabolic syndrome and other factors contributing to the regression in progress of reducing cardiac events [27:00];
GLP-1 agonists—Promising drugs for treating diabetes and obesity [33:30];
Female-specific risk factors for ASCVD (pre- and post-menopause) [37:15];
Polycystic ovary syndrome (PCOS): prevalence, etiology, and impact on metabolic health, lipids and fertility [47:00];
The effect of grand multiparity (having 5+ children) on cardiovascular disease risk for women [52:30];
The impact of oral contraceptives on cardiovascular disease risk [55:00];
The effect of pregnancy on lipids and other metabolic parameters [58:45];
The undertreatment of women with familial hypercholesterolemia (FH) and how it increases lifetime risk of ASCVD [1:02:00];
How concerns around statins have contributed to undertreatment, and whether women should stop statins during pregnancy [1:09:45];
How Erin approaches the prescription of statins to patients [1:16:00];
PCSK9 inhibitors and other non-statin drugs [1:21:15];
Advice for the low- and high-risk individual [1:28:30];
The impact of nutrition, stress, and lifestyle on lipids and CVD risk [1:31:00];
Lp(a) as a risk enhancer for cardiovascular disease [1:41:15];
The effect of menopause on cardiovascular disease risk [1:50:30];
How Erin approaches decisions regarding hormone replacement therapy (HRT) for her patients [1:55:30];
The urgent need for more data on women’s health [2:03:30];
Erin’s goal of running a marathon in every state [2:09:45]; and
More.

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#229 ‒ Understanding cardiovascular disease risk, cholesterol, and apoB Oct 31, 2022

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In this special episode of The Drive, we have pulled together a variety of clips from previous podcasts about cardiovascular disease to help listeners understand this topic more deeply, as well as to identify previous episodes which may be of interest. In this episode, Peter highlights the importance of understanding cardiovascular disease and why early intervention is critical. He also provides a primer on lipoproteins and explains the fallacy of the terms “good cholesterol” and “bad cholesterol.” Allan Sniderman discusses the metrics measured in routine blood work – along with the limitations of those standard panels – before explaining why apoB is a superior metric for determining risk. Additionally, Tom Dayspring explains the causal role of apoB in atherosclerotic cardiovascular disease (ASCVD) and the therapeutic goals for apoB concentration, and Peter explains how early and aggressive lowering of apoB could change the landscape of cardiovascular disease prevention.

We discuss:

The importance of understanding atherosclerosis early in life [2:25]
Defining ASCVD, its causes, and the role of cholesterol [8:00];
Why early prevention of atherosclerosis is critical [13:45];
Preventing atherosclerosis—two fatal flaws with the “10-Year Risk” approach [16:00];
Intro to lipids and lipoproteins: why there is no “bad” or “good” cholesterol [23:00];
Limitations of standard blood panels [35:45];
How Mendelian randomization is bolstering the case for apoB as the superior metric for risk prediction [39:30];
Therapeutic goals for apoB concentration [58:15];
How early and aggressive lowering of apoB could change the course of ASCVD [1:10:45]; and
More.

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#228 ‒ Improving body composition, female-specific training principles, and overcoming an eating disorder | Holly Baxter, APD Oct 24, 2022

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Holly Baxter is an accredited practicing dietician (APD), competitive bodybuilder, fitness and nutrition educator, and coach. In this episode, Holly discusses her experience as an athlete and competitive bodybuilder. She also opens up about her struggles with mental health, her long battle with an eating disorder, and the important steps she’s taken in her road to recovery. From there, she explains how she would design a nutrition and training program for a hypothetical female client wanting to improve her physique through the addition of lean muscle and loss of body fat. She explains reasonable expectations for gaining muscle and the value of a “reverse diet” for maintaining weight loss, and she shares her favorite exercises. She also talks through some female-specific training considerations such as programming, reps, volume, hormone replacement therapy, and more.

We discuss:

Holly’s background and passion for sports and nutrition [2:00];
Holly’s struggle with depression and an eating disorder [4:30];
Reflecting on her eating disorder, body image, and a wake up call [18:15];
Road to recovery: therapy, meditation, self-compassion, and a breakthrough [27:45];
The effect of competitive bodybuilding on women [39:00];
Holly’s competition prep and how she guides her clients wanting to improve their physique [46:45];
Training principles for muscle hypertrophy [57:00];
Training advice for an inexperienced person wanting to build muscle [1:01:30];
Training program for a hypothetical woman wanting to add lean muscle and lose body fat [1:04:15];
Lower body lifts: Holly’s approach to leg workouts with clients [1:14:00];
Upper body exercises: Holly’s approach with her clients [1:24:45];
Importance of nutrition and protein during the muscle building phase [1:34:00];
Changes to nutrition and training during a fat loss phase [1:40:30];
A “reverse diet” after a cutting phase to help prevent weight gain [1:49:45];
Female-specific training considerations: programming, reps, volume, sex hormones, and more [1:53:15];
Holly’s future in bodybuilding and helping struggling women [2:05:45];
Looking forward: Holly’s focus on longevity, bone mineral density, and wellness [2:08:15]; and
More.

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#227 - AMA #40: Body composition, protein, time-restricted feeding, fasting, DEXA scans, and more Oct 17, 2022

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In this “Ask Me Anything” (AMA) episode, Peter discusses the importance of understanding body composition and explains how to interpret the most important metrics revealed by a DEXA scan, such as lean muscle tissue mass, visceral adiposity tissue mass, bone mineral density, and more. He discusses common concerning trends in these metrics as well as strategies to address them. He goes through DEXA scan results of both male and female patient case studies and explains the prescribed intervention for each patient. Additionally, Peter answers numerous questions about dietary protein including how much we need, when we need it, and how intake should be divided throughout the day to optimize muscle protein synthesis. Finally, Peter provides his updated point of view on time-restricted feeding and fasting and how his personal approach and recommendations for patients has evolved.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #40 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Interpreting DEXA scans: important metrics, radiation levels, and more [2:15];
DEXA metrics: Bone mineral density (BMD) [12:00];
DEXA metrics: Visceral adipose tissue (VAT) [14:30];
DEXA metrics on lean tissue: appendicular lean mass index (ALMI) and fat-free mass index (FFMI) [20:45];
Concerning trends in BMD, VAT, & muscle mass revealed through DEXA scans [24:15];
Muscle and lean tissue loss with age and how to overcome anabolic resistance [29:15];
Female patient case studies: DEXA scan results and prescribed interventions [35:00];
Male patient case studies: DEXA scan results and prescribed interventions [42:45];
Protein consumption: recommended daily intake, Peter’s personal approach, timing around workouts, and more [48:15];
What to look for with protein supplements [53:15];
Protein intake: optimal timing and how it should be divided throughout the day [55:30];
Time-restricted feeding (TRF): Peter’s updated perspective [57:45];
Three strategies for reducing energy intake in over-nourished patients [1:03:15];
Prolonged fasting: potential benefits and tradeoffs [1:07:15];
A protein-supplemented version of time-restricted feeding (TRF) [1:09:30];
Theories about time-restricted feeding (TRF) and its positive influence on sleep and circadian rhythm [1:12:00]; and
More.

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#226 ‒ The science of happiness | Arthur Brooks, Ph.D. Oct 10, 2022

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Arthur Brooks is a social scientist, professor at Harvard University, a columnist for The Atlantic, and the bestselling author of From Strength to Strength. In this episode, Arthur explains how intelligence changes as we get older, and how to take advantage of this to maximize our happiness and success. He distills truths about the meaning of happiness and its three main components: enjoyment, satisfaction, and purpose. He goes into detail about many of the keys to a happy life, including the importance of cultivating virtuous relationships. On the flip side, Arthur warns of the dangers of social comparison, “success addition,” and the four worldly idols—money, fame, power, and pleasure—that drive many of us. Additionally, Arthur provides examples of exercises that can guide one in the right direction, overcome fear, and cultivate habits that can lead to a happier life.

We discuss:

Insights from Arthur’s career as a professional French horn player [2:15];
A radical shift away from music to a Ph.D. in quantitative policy [12:00];
Personal experience with shifting intelligence: fluid vs. crystallized intelligence [16:45];
An epiphany from a chance encounter on an airplane that shaped Arthur’s thinking [22:00];
The three main “macronutrients” of happiness [25:00];
Exploring the “purpose” component of happiness [29:00];
The importance of having a partner and true friendships [32:00];
The makeup of a true friendship, and why men tend to struggle with making real friends [36:45];
The “satisfaction” component of happiness and the importance of “wants management” [42:15];
The tyranny of social comparison [47:45];
Insights into happiness through Chinese art, and the concept of a “reverse bucket list” [51:45];
An exercise demonstrating the importance of relationships with others and the need to work on them [55:30];
The four main idols that drive us: money, fame, power, and pleasure [1:01:15];
Success addiction, workaholism, and their detriment to happiness [1:04:00];
A radical approach to overcome fear—the antithesis to love and happiness [1:14:00];
Ancient Hindu advice for the perfect life [1:26:30];
The end result of getting caught in the 4 idols [1:31:45];
The complexity of happiness [1:33:30]; and
More.

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#225 ‒ The comfort crisis, doing hard things, rucking, and more | Michael Easter, MA Oct 03, 2022

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Michael Easter is the author of the bestseller, The Comfort Crisis. He’s also a journalist, Professor of Journalism at UNLV, and a leading voice on how humans can integrate modern science and evolutionary wisdom for improved health, meaning, and performance in life and at work. In this episode, Michael first talks about his upbringing, including his parents' struggle with alcoholism, his father leaving when he was young, and how these things impacted Michael's own struggle with alcoholism. He explains what led to his realization that we are in a “crisis of comfort” and how the removal of many of life’s discomforts through advancements in modern society may actually be a leading contributor to many of our most urgent physical and mental health issues. He explains the benefits of challenging oneself and the immense positive carryover which can come from doing things we find difficult. He describes the consequences of technology like smartphones, which have effectively eliminated boredom—a discomfort that comes with many benefits. He tells the story of a profound experience at an elk hunt that changed Michael’s thoughts around life and death, how happiness can thrive in places without all of the modern comforts of the West, and why we’re hardwired for stress and what to do about it. They conclude with a conversation around rucking, an activity with many physical and mental benefits.

We discuss:

The value in doing something difficult [2:30];
Michael’s upbringing with a single parent and alcoholism [5:45];
Michael’s battle with alcoholism and his experience with quitting drinking [10:00];
Origin of the idea that we are in a crisis of comfort [20:30];
The death of boredom in modern society [28:45];
The benefits of boredom [36:00];
The value of disconnecting and being in nature [39:15];
Changing the dynamic of how we think about food and the story of Peter’s daughter’s first hunt [43:45];
How a profound experience at an elk hunt changed Michael’s thoughts about life and death [49:15];
How happiness can thrive in places without all of the modern comforts of the West [57:15];
Why we’re hardwired for stress, and the responsibility that comes with our level of comfort [1:05:30];
How perspective on the timescale of our lives in relation to history can impart positive changes [1:14:00];
The benefit of challenging oneself and the positive carryover it can have [1:19:45];
The many benefits of rucking [1:28:45];
Tips for rucking: ideal load, type of pack, and other considerations [1:38:00];
Parting thoughts on the downside of comfort and benefits of difficult things [1:43:00]; and
More.

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#224 ‒ Dietary protein: amount needed, ideal timing, quality, and more | Don Layman, Ph.D. Sep 26, 2022

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Don Layman is a Professor of Food Science and Human Nutrition at the University of Illinois Urbana-Champaign. He has spent the past 40 years investigating the role of dietary protein in muscle protein synthesis. In this episode, Don describes how his decades of research have shaped his thinking around protein, muscle, anabolic factors, metabolism, and more. He explains the recommended dietary allowance (RDA) for protein: what it is, how it came about, and how it should serve only as a guide for the minimum protein necessary for survival rather than as an optimal level of protein intake. He provides an overview of the essential amino acids, explains the nuances of animal versus plant protein, and provides insights for determining protein quality, absorption rates, and how to best track your intake. He discusses the ideal timing of protein intake in relation to resistance exercise, how protein should be distributed among meals, and how limitations in protein utilization per sitting can impact those practicing time-restricted eating. Additionally, Don shares results from his clinical trials, including how a high-protein diet fared in terms of fat loss, and explains the differences in protein utilization between adolescents and adults and how the problem of reduced efficiency of protein utilization in older adults can be overcome.

We discuss:

Don’s background: from growing up on a farm to studying nutritional biochemistry [2:30];
Don’s philosophy on nutrition, muscle, and metabolism [6:30];
The controversial relationship between saturated fat and atherosclerosis [18:15];
The basics of protein and amino acids [25:45];
Origin and limitations of the current recommended dietary allowance (RDA) for protein intake [32:15];
Protein sources: determining quality, absorption rates, and how to track intake [41:15];
Leucine, lysine, and methionine: three important essential amino acids [48:00];
The vital role of ruminant animals in the production of quality protein [53:15];
The differing needs and impacts of dietary protein for a 16-year old compared to a 65-year old [59:30];
Consequences of protein deficiency in childhood [1:06:30];
Muscle protein synthesis: ideal timing, small meals vs. big meals, and more [1:12:45];
Protein needs of children [1:19:45];
How important is timing protein intake around training? [1:24:15];
The role of leucine in fatty acid oxidation by muscle [1:28:15];
High protein diets for fat loss: Results from Don’s clinical trials [1:31:30];
Influence of industry funding on nutrition studies [1:43:45];
Don’s thoughts on plant-based and synthetic “meats” [1:48:45];
Problems with epidemiological studies of dietary protein [1:56:30];
More.

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#223 - AMA #39: The Centenarian Decathlon, zone 2, VO2 max, and more Sep 19, 2022

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In this “Ask Me Anything” (AMA) episode, Peter describes what it means to exercise with the goal of longevity in mind, including his personal goals, exercise framework, and how he is optimizing for what he refers to as the “Centenarian Decathlon.” He explains the various types of cardiovascular training and how to partition your time between intensity levels (i.e., zone 2 training vs. zone 5 training) to optimize cardiorespiratory benefit. Additionally, Peter dives deep into questions around VO2 max, such as why it’s critical for longevity, how to improve it, and the value in starting VO2 max optimization early in life.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #39 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Exercise topics to be discussed [1:45];
Peter’s exercise goals, and the Centenarian Decathlon [4:00];
Peter’s exercise framework, and how he tracks his MET hours [8:30];
How to partition your time between low and high intensity exercise to optimize results [13:15];
Zone 2 exercise: ideal training methods and how to determine your zone 2 level [23:15];
Rucking as a versatile mode of exercise [31:45];
Zone 5 exercise: modalities of training, time per week, and other considerations [34:30];
The importance of knowing your VO2 max, and methods for estimating it [38:15];
Training methods for improving VO2 max, and realistic targets for improvement [46:00];
Relationship of VO2max with age and the required fitness levels for daily life activities and exercise [52:30];
The training necessary to maintain an elite VO2 max throughout life [58:45];
The value in starting early: the compounding nature of fitness [1:01:45]; and
More.

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#222 ‒ How nutrition impacts longevity | Matt Kaeberlein, Ph.D Sep 12, 2022

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Dr. Matt Kaeberlein is a globally recognized expert on the biology of aging and recurring on The Drive. In this episode, Matt explains his research findings on nutrition as it relates to aging and longevity, including the results from his recent review article in Science. From there, he and Peter dive deep into the literature on calorie restriction (CR), explaining the nuance, benefits for lifespan and healthspan, and potential downsides of CR. He discusses the epigenetic changes that occur with age and potential benefits and downsides of epigenetic reprogramming, often viewed as a panacea for reversing aging. Matt also explains the impact of dietary protein on aging, including the interesting dichotomy around how protein, a critical macronutrient, and rapamycin, a geroprotective molecule, have opposite effects on mTOR. Additionally, he talks about low-protein vs. high-protein diets and their effects on muscle mass and mortality, as well as the impact of IGF-1 signaling and growth hormone on lifespan.

We discuss:

Challenges with understanding the effects of nutrition and studying interventions for aging [3:30];
How Peter’s and Matt’s convictions on nutrition and thoughts optimal health have evolved [8:15];
Calorie restriction for improving lifespan in animal models [16:15];
Utility of epigenetic clocks and possibility of epigenetic reprogramming [22:00];
Mutations and changes to the epigenome with aging [31:45];
Epigenetic reprogramming: potential benefits and downsides and whether it can work in every organ/tissue [35:15];
First potential applications of anti-aging therapies and tips for aging well [43:00];
Impact of calorie restriction on the immune system, muscle mass, and strength [47:00];
Insights from famous calorie restriction studies in rhesus macaques [55:00];
An evolutionary perspective of the human diet [1:03:45];
Antiaging diets: Separating fact from fiction—Matt’s 2021 review in Science [1:12:30];
Mouse models of time-restricted feeding in the context of calorie restriction [1:19:30];
Nutritional interventions that consistently impact lifespan in mice, and concerns around efficacy in humans [1:27:00];
Differing impact of calorie restriction when started later in life [1:31:00];
Lifespan extension with rapamycin in older mice [1:37:15];
Relationship between protein intake and aging, and mouse studies showing protein restriction can extend lifespan [1:43:30];
Impact of protein intake on mTOR, and why inhibition of mTOR doesn’t cause muscle loss [1:50:45];
Low-protein vs. high-protein diets and their effects on muscle mass, mortality, and more [1:55:30];
The impact of IGF-1 signaling and growth hormone on lifespan [2:06:30];
Parting thoughts on the contribution of nutrition to healthspan and lifespan [2:19:45];
More.

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#221 ‒ Understanding sleep and how to improve it Sep 05, 2022

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In this special episode of The Drive, we have pulled together a variety of clips from previous podcasts with sleep expert Dr. Matthew Walker to help listeners understand this topic more deeply, as well as to identify which previous episodes featuring Matt may be of interest. In this episode, Matt gives an overview of why we sleep, the stages of sleep, and sleep chronotypes, and he provides tips to those looking to improve their total sleep and sleep efficiency. Additionally, Matt discusses the pros and cons of napping, and gives his current thinking on the effects of blue light and caffeine on sleep. Finally, Matt explains the dangers of sleeping pills and reveals what he believes are the most useful alternatives for someone struggling with sleep, such as those with insomnia.

We discuss:

Evolutionary reasons to sleep [2:15];
Stages of sleep, sleep cycles, and brainwaves [10:00];
Understanding sleep chronotypes and how knowing yours could help you [25:45];
Defining sleep efficiency and how to improve it [36:15];
Correcting insomnia: a counterintuitive approach [38:45];
Pros and cons of napping, and insights from the sleep habits of hunter-gatherer tribes [41:30];
Sleep hygiene, wind-down routine, and tips for better sleep [50:15];
The optimal room temperature and body temperature for the best sleep [59:30];
Blue light: how Matt shifted his thinking [1:08:30];
Caffeine: how Matt has adjusted his hypothesis [1:14:45];
The dangers of sleeping pills, useful alternatives, and cognitive behavioral therapy for insomnia [1:19:45];
More.

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#220 ‒ Ketamine: Benefits, risks, and promising therapeutic potential | Celia Morgan, Ph.D. Aug 29, 2022

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Celia Morgan is a Professor of Psychopharmacology at the University of Exeter who has authored numerous publications on the potential therapeutic uses of ketamine in mental healthcare. In this episode, Celia dives deep into the neurobiology of ketamine, how it affects users, and how it differs from other, more classical psychedelics (LSD, MDMA, PCP, and psilocybin). She explains the potential promise of ketamine as a treatment for recalcitrant depression and addiction, and she details the results from her clinical trials in these areas. She discusses the importance of using ketamine in combination with psychotherapy to maximize its benefits, the potential risks associated with ketamine use, and advice for those interested in the therapeutic use of ketamine.

We discuss:

Celia’s training and interest in ketamine [2:15];
The history of ketamine, medical uses, and use as a party drug [3:30];
Neurobiology and pharmacology of ketamine [8:15];
Ketamine regulation and abuse, and how it compares with psychedelics and other molecules [18:15];
Ketamine as a therapeutic for depression [30:45];
The brain under the influence of ketamine and theoretical mechanisms for its anti-depressive effects [48:00];
Risks and concerns with overusing ketamine, and what an intermittent or maintenance dose might look for a patient [57:15];
Treating addiction with ketamine: Celia’s studies of alcohol dependance [1:04:00];
Advice for people considering the therapeutic use of ketamine [1:19:45];
More.

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#219 ‒ Dialectical behavior therapy (DBT): skills for overcoming depression , emotional dysregulation, and more | Shireen Rizvi, Ph.D., ABPP Aug 22, 2022

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Shireen Rizvi is a Professor of Clinical Psychology and Psychiatry at Rutgers University, where she is also the Director of the Dialectical Behavior Therapy Clinic. This episode focuses specifically on dialectical behavior therapy (DBT), a skills-based technique which was originally developed to treat borderline personality disorder (BPD) and has since been adapted to treat depression and other mental health conditions, as well as to help people who have difficulty with emotional regulation and self-destructive behaviors. Shireen explains the origins of DBT and how its creator, Dr. Marsha Linehan, came to find a need for something beyond cognitive behavioral therapy (CBT) when attempting to treat patients with suicidal behavior. From there, Shireen dives into how DBT works to resolve the apparent contradiction between self-acceptance and change to bring about positive changes in emotional regulation, interpersonal effectiveness, mindfulness, distress tolerance, and more. She also provides examples for how one can apply specific skills taught with DBT such as accessing the “wise mind,” applying radical acceptance, using the “DEAR MAN” technique, and utilizing an emotion regulation skill called “opposite action.” Finally, she explains how the tenets of DBT offer benefits to anyone, and she provides insights and resources for people wanting to further explore DBT.

We discuss:

The basics of dialectical behavior therapy (DBT) and how it differs from cognitive behavioral therapy (CBT) [3:00];
Treating depression with CBT: history, effectiveness, and how it laid the groundwork for DBT [8:15];
Marsha Linehan’s inspiration for developing DBT [16:00];
Explaining borderline personality disorder (and associated conditions) through the lens of DBT [20:00];
How work with suicidal patients led to the development of DBT—a dialectic between change and acceptance [35:30];
Details of DBT: defining the term “dialectical” and how to access the “wise mind” [44:30];
Practicing mindfulness and radical acceptance in the context of DBT [51:00];
Applying “radical acceptance” to tragic scenarios [1:02:00];
The five domains of skills taught in DBT [1:07:15];
Why Marsha chose borderline personality disorder as her focus when developing DBT [1:13:30];
Is there any benefit in doing DBT for someone without a pathological condition? [1:15:45];
The DEAR MAN skill of DBT [1:20:00];
Adapting DBT skills for adolescents and families [1:31:00];
Identifying vulnerability factors, increasing distress tolerance, and the impact of physical pain [1:33:45];
The DBT chain analysis: assessing problem behaviors and identifying vulnerability factors [1:44:30];
Why the regulation of emotions can be so challenging [1:50:30];
The importance of mindfulness skills in DBT [1:53:30];
Opposite action: an emotion regulation skill [1:57:00];
Advice for those wanting to explore DBT [2:03:15];
Finding a well-trained DBT therapist [2:08:15];
More.

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#218 - AMA #38: Can you exercise too much? Aug 15, 2022

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In this “Ask Me Anything” (AMA) episode, Peter dives deep into the question of whether there is such a thing as “too much exercise.” He explores the theoretical “J-curve” relationship between exercise and longevity, whereby mortality risk declines with increasing activity levels only to see an uptick above a certain exercise volume threshold. While Peter maintains that exercise is perhaps the single most important tool we have to live longer and live better, he explains the challenges involved in identifying an optimal dose. He takes a hard look at studies—many of which have contradictory results—to highlight major limitations in methodology and how readers could be misled. Additionally, he discusses the rare, but real, risks associated with extreme levels of physical activity and concludes by weighing the benefits against the risks of exercise.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #38 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

How exercise reduces risk for all-cause mortality [2:40];
Defining the metric called “MET” and how it’s useful for evaluating different exercises [8:00];
The challenge in determining the optimal exercise doses and the limitations of methods used to study the effect of exercise [13:45];
Using VO2 max as a proxy for fitness to better predict mortality risk [19:30];
Reviewing data which support the theory of a “J-curve” relationship between exercise and longevity [25:00];
Importance of understanding p-values and statistical significance [33:45];
Deconstructing the studies that show a J-curve: major limitations and how one could be misled [37:00];
Peter’s takeaways on the theoretical “J-curve” relationship between exercise and longevity [51:30];
Risk of sudden cardiac death from vigorous physical exertion [54:00];
Atrial fibrillation associated with extreme levels of exercise [1:00:15];
Parting thoughts: benefits of exercise far outweigh the risks [1:04:15]; and
More.

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#217 ‒ Exercise, VO2 max, and longevity | Mike Joyner, M.D. Aug 08, 2022

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Mike Joyner is a physician-researcher and one of the world’s leading experts on human performance and exercise physiology. In this episode, Mike discusses how to combat age-related declines in health and fitness levels by using various modes of exercise to improve lifespan and healthspan. Mike explains the impact of exercise on the autonomic nervous system, blood pressure, heart rate, heart rate variability, heart rate recovery, and max heart rate. He dives deep into VO2 max, including how it’s measured, what is driving it, and how to improve it. Mike provides training insights for the average person, including training volume and exercise intensity as well as simple metrics to track. Furthermore, he gives his take on the theoretical “J-curve” relationship between exercise and longevity, as well as whether possible health dangers may be associated with excessive exercise.

We discuss:

Mike’s training as an anesthesiologist and interest in exercise physiology [2:30];
How exercise increases longevity [7:00];
The impressive data on the benefits of exercise [9:45];
The Centenarian Olympics and other ways to mitigate age-related decline in strength and stability [15:00];
The violent dropoff in strength and activity with age and how exercise preserves fitness in old age [19:00];
Benefits of exercise on mortality and fracture risk, and the interplay of nutrition and exercise [22:00];
How exercise benefits the autonomic nervous system and why this plays an important role in our health [26:30];
VO2 max, heart rate recovery, heart rate variability, and other metrics of fitness positively impacted by exercise [28:30];
Reduction in all-cause mortality with increased fitness levels and VO2 max [32:45];
Does the relationship between exercise and longevity follow a J-curve? [40:00];
Mitigating age-related decline in fitness by elevating your VO2 max at a young age [46:15];
Breaking down the variables that drive VO2 max [54:30];
Learning from elite athletes: Training regimens, aerobic efficiency, and other impressive metrics [1:00:15];
Health benefits of light exercise for the average person [1:09:00];
Simple training metrics to track, and Mike’s current exercise regimen [1:11:15];
How to boost your VO2 max, and the importance of form and tempo with interval training [1:18:15];
Training advice for the average person [1:25:15];
Why professional athletes have longer careers than they’ve had in the past [1:27:30];
Use of performance-enhancing drugs in professional sports [1:29:45];
Can the miracle of exercise be put in a pill? [1:36:00];
Mike’s current research and questions he’s most interested in answering [1:39:00];
Use of convalescent plasma to treat COVID-19 [1:41:15];
Parting thoughts on the current state of fitness and exercise in society [1:47:15];
More.

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#216 - Metabolomics, NAD+, and cancer metabolism | Josh Rabinowitz, M.D., Ph.D. Aug 01, 2022

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Josh Rabinowitz is a Professor of Chemistry and Integrative Genomics at Princeton University, where his research focuses on developing a quantitative, comprehensive understanding of cellular metabolism through the study of metabolites and their fluxes. In this episode, Josh focuses the discussion on three main topics: metabolomics, NAD (and its precursors), and cancer metabolism. The metabolomics discussion starts with a broad definition of metabolism, metabolites, and fluxomics before diving deep into glucose metabolism, lactate as a fuel, movement of lactate, and the regulation of these substrates. He then gives a detailed explanation of the electron transport chain and Krebs cycle and their implications with respect to both drugs and nutrition while also explaining how NAD is central to the process of energy generation. He then discusses the age-related decline in NAD and what current literature says about efforts to increase NAD through intravenous or oral supplementation with the precursors NMN and NR, including whether doing so provides any advantage to lifespan or healthspan. Finally, Josh ends the conversation talking about cancer metabolism and how one particular intersection between cancer metabolism and immunotherapy might provide a hopeful outlook on the future of cancer treatment.

We discuss:

Josh’s background and unique path to becoming a research scientist at Princeton [3:30];
What sparked Josh’s early interest in metabolism [11:15];
Metabolomics 101: defining metabolites and how they are regulated [16:30];
Fluxomics: metabolism as a system in action [26:00];
The Randle Hypothesis: glucose and fatty acids compete as substrates for oxidation [33:30];
The important role of lactate as an alternate fuel [36:30];
Fasting lactate levels as a potential early indicator of metabolic dysfunction [48:00];
The beauty of the Krebs cycle and the role of NAD in energy production [53:15];
How the drug metformin acts on complex I of the electron transport chain [1:05:00];
The difference between NADH and NADPH [1:08:45];
NAD levels with age, and the efficacy of supplementing with intravenous NAD [1:10:45];
The usefulness of restoring NAD levels and efficacy of oral supplementation with NAD precursors NR and NMN [1:22:15];
Exploring the hypothesis that boosting NAD levels is beneficial [1:32:30];
Cancer metabolism and the intersection with immunotherapy [1:39:00];
Making cancer a chronic disease: exploiting the metabolic quirks of cancer, augmenting the immune system, and more [1:46:15];
The challenge of treating pancreatic cancer [1:50:30];
Epithelial cancers that might respond to metabolic approaches to therapy [1:56:30];
Josh’s hopeful outlook on the future of cancer treatment [1:59:00];
Nutritional approaches to cancer attenuation [2:00:15];
What makes Princeton University special [2:06:15];
More.

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#215 - The gut-brain connection | Michael Gershon, M.D. Jul 25, 2022

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Mike Gershon is a Professor of Pathology and Cell Biology at Columbia University and has been at the forefront of studying neural control of the gut for the past 60 years. In this episode, Mike gives a tour de force on the pathways of gut-brain communication but first sets the stage with an overview of gastrointestinal tract development and anatomy. He then explains how the gut communicates with the brain and vice versa, from early observations in physiology and anatomy up to our present understanding of what makes the GI tract so unique and complex relative to other organs. He talks about how the gut responds to meals of different food qualities and how that affects satiety signaling to the brain. Additionally, he explains how antidepressants and other drugs impact digestion through effects on serotonin signaling, and he discusses the effects of antibiotics, and what’s really going on with “leaky gut.” Finally, Mike offers his thoughts on the utility—or lack thereof—of gut microbiome diagnostic tests, and wraps up the discussion by considering how diet, probiotics, and prebiotics impact the microbiome and GI tract.

We discuss:

The basics of the gastrointestinal (GI) system [3:45];
The very early development of the GI system [9:30];
The unique properties of the blood supply and portal system in the GI tract [12:45];
An overview of gut anatomy and innervation [16:30];
Turnover of the epithelial lining and why cancer rarely develops in the small intestine [26:45];
Nutrient and water absorption in the small and large intestine [30:30];
Ways in which the gut and brain communicate [34:30];
The gut's role in the regulation of appetite [43:30];
The impact of gastric bypass surgery on satiety signals [51:15];
How varicella-zoster virus (VZV) can infect neurons in the gut and create issues later in life [54:30];
The relationship between autism and gastrointestinal illness [1:02:45];
The important role of serotonin in the gut, and the impact of SSRIs on serotonin in the gut [1:09:45];
Defining “leaky gut” and its most common causes [1:16:45];
The gut microbiome [1:30:45];
Fecal transplants: use cases, limitations, and how they illustrate the importance of gut microbes [1:40:45];
Gut microbiome diagnostic tests: why they aren’t useful outside of special cases such as cancer detection [1:50:30];
Nutritional approaches to a maintain optimal flora in the gut [1:55:00];
Prebiotics and probiotics, and getting your GI system back on track after a course of antibiotics [2:02:30];
More.

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#214 - AMA #37: Bone health—everything you need to know Jul 18, 2022

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In this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of bone health and explains why this is an important topic for everyone, from children to the elderly. He begins with an overview of bone mineral density, how it's measured, how it changes over the course of life, and the variability between sexes largely due to changes in estrogen levels. From there he provides insights into ways that one can improve bone health, from exercise to nutrition supplements to drugs. Additionally, Peter discusses what happens when one may be forced to be sedentary (e.g., bedrest) and how you can work to minimize the damage during these periods.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #37 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Overview of bone health topics to be discussed [1:45];
Bones 101: bone function, structure, and more [5:15];
Bone mineral density (BMD), minerals in bone, role of osteoblasts and osteoclasts, and more [8:30];
The consequences of poor bone health [13:30];
The devastating nature of hip fractures: morbidity and mortality data [17:00];
Where fractures tend to occur in the body [23:00];
Defining osteopenia and osteoporosis [24:30];
Measuring BMD with DEXA and how to interpret scores [27:00];
Variability in BMD between sexes [34:15];
When should people have their first bone mineral density scan? [36:45];
How BMD changes throughout the life and how it differs between men and women [39:00];
How changes in estrogen levels (e.g., menopause) impact bone health [44:00];
Why HRT is not considered a standard of care for postmenopausal bone loss [47:30];
Factors determining who may be at higher risk of poor bone health [50:30];
Common drugs that can negatively impact BMD [54:15];
How children can optimize bone health and lay the foundation for the future [57:45];
Types of physical activity that can positively impact bone health [1:02:30];
How weight loss can negatively impact bone health and how exercise can counteract those effects [1:10:45];
Nutrition and supplements for bone health [1:14:15];
Pharmaceutical drugs prescribed for those with low BMD [1:17:15];
Impact of extreme sedentary periods (e.g., bedrest) and how to minimize their damage to bone [1:22:00]; and
More.

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#213 ‒ Liquid biopsies and cancer detection | Max Diehn, M.D. Ph.D. Jul 11, 2022

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Max Diehn is a Professor of Radiation Oncology at Stanford and a clinical radiation oncologist specializing in lung cancer. Max’s research focuses on developing novel methods for detecting circulating tumor DNA in the blood of cancer patients and on elucidating the molecular pathways and genes associated with cancer. His interests also include uncovering biomarkers that can predict patient survival, responses to therapy, and disease recurrence. In this packed episode, Max discusses the history of blood-based cancer screening and the importance of understanding the predictive value of tests—sensitivity, specificity, negative predictive value, positive predictive value – and how these metrics play into cancer screening. Max then goes in depth on the topic of liquid biopsies, including the history, current landscape, and possible future of liquid biopsies as a cancer detection tool. He discusses how these non-invasive blood tests can detect DNA/RNA from tumor cells released into the blood as well as the different methods one can use to predict if a cancer is present. He gets granular on the topic of cell-free DNA/RNA signature, methylation patterns, and the importance of knowing mutation information, and he ends with a discussion on the exciting future of liquid biopsies and how we can possibly get to the panacea of cancer screening.

We discuss:

Max’s training that planted the seeds for development of liquid biopsies [4:30];
Max’s decision to specialize in radiation oncology [11:45];
A culture at Stanford that values research and physician scientists [17:00];
The motivation to develop liquid biopsies [19:15];
History of blood-based cancer screening and understanding the predictive value of tests [25:30];
Current state of lung cancer and the need for better screening [32:45];
Low-dose CT scans: an important tool for managing lung cancer but with limitations [42:00];
Using liquid biopsies to identify circulating tumor cells [47:00];
Liquid biopsy research moves from circulating tumor cells to cell-free DNA [1:03:00];
Zeroing-in on circulating tumor DNA in cell-free DNA [1:10:48];
Cell-free RNA and Max’s vision for cancer detection from a blood sample [1:22:00];
Methylation patterns and other informative signatures found in DNA [1:24:30];
Mutation-based methods of liquid biopsies [1:26:30];
Understanding the sensitivity and specificity of a diagnostic test [1:30:30];
Existing clinical liquid biopsy tests and their limitations [1:37:30];
The future of liquid biopsies [1:44:00];
How we get to the panacea of cancer screening [1:52:00];
More.

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Earning the gift of life | Ric Elias (#79 rebroadcast) Jul 04, 2022

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In this episode, Ric Elias, founder of Red Ventures, opens up about the fateful day he knew for certain that he was going to die as a passenger on US Airways Flight 1549. Ric dives deep into how that day impacted his life, greatly changed his perspective, and improved his relationship with his family and the broader community. We also talk about his incredible role as CEO of an enormous company, his remarkable work in philanthropy, and all the wisdom he has acquired in his extraordinary life.

We discuss:

Ric’s life leading up to the day of the plane crash [2:15];
The plane crash—What it’s like knowing you’re about to die, feelings of regret and sadness [8:00];
The improbable plane landing in the Hudson River [15:45];
Emotions after the safe landing (and a story he’s never told before) [22:15];
A powerful story about Captain Sully [26:15];
Earning his second chance at life, and playing the “infinite game” [35:15];
Why time is the ultimate currency, and how (and why) to say “no” [43:00];
Raising kids in an achievement culture, Ric’s definition of life success, and what Ric wants to instill in his kids [49:45];
What Ric believes is actually worth getting upset about, and the organizations that are taking steps to help people [1:05:45];
The core principles of Red Ventures (Ric’s company) [1:16:00];
Ric’s tips for developing business acumen and negotiation skills [1:26:15];
What qualities does Ric look for in people he wants to work with? [1:29:15];
What is the next big problem that Ric wants to solve? [1:32:15];
What is the most challenging part of your business today? [1:34:15];
If Ric could go back and talk to himself in the morning before getting on that plane, what would he say? [1:36:00]; and
More.

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#212 - The neuroscience of obesity | Stephan Guyenet, Ph.D. Jun 27, 2022

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Stephan Guyenet is a neuroscientist focused on the neuroscience of obesity and energy homeostasis. He is the author of the book, The Hungry Brain and founder/director of Red Pen Reviews. In this episode, Stephan explains how obesity has changed phenotypically over the course of human history as well as what might explain the dramatic increase in prevalence of obesity in the last few decades. He talks in depth about the role of genetics, the brain, and hormones like leptin play in the regulation of fat mass. He dives deep into two common theories of obesity—the carbohydrate-insulin model and the energy balance model and provides his take on which theory has stronger evidence. Additionally, he provides insights on how we’re hard-wired to think about food and the consequences of modern foods designed for maximal pleasure. Finally, he goes through the factors that affect body weight, set points, and provides takeaways for people wanting to take advantage of what we know about the brain’s role in regulating our body weight.

We discuss:

Stephan’s neuroscience background and his focus on the nuances of obesity [2:15];
How obesity has changed for humans throughout history [8:00];
The association between obesity and adverse health outcomes, the “obesity paradox,” and confounders when relating BMI to longevity [14:00];
The sharp increase in obesity across demographics [23:30];
The hypothalamus and its role in obesity [30:00];
The role of the hormone leptin in obesity [40:00];
The genetic component of obesity [46:30];
Understanding the tendency of humans to store fat through an evolutionary lens [57:00];
The hedonic aspect of food, and how the brain reacts to modern, highly-rewarding foods [1:03:30];
How we are hard-wired to think about food [1:14:30];
A review of the “Carnivore diet” [1:21:45];
The energy balance model, carbohydrate-insulin model, and unifying the theories around adiposity [1:34:15];
Body weight set points: a hypothetical comparison of two individuals [1:41:45];
Takeaways for people who want to lose weight and keep it off [1:48:30];
Evidence that favors the energy balance model of weight gain [1:56:00];
The synergistic effect of fat and carbohydrates and observations that a low-fat diet or a low-carb diet can cause weight loss [2:04:30];
Red Pen Reviews [2:11:00];
More.

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#211 - AMA #36: Fruits & vegetables—everything you need to know Jun 20, 2022

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In this “Ask Me Anything” (AMA) episode, Peter discusses the nutritional profiles of various fruits and vegetables as a means of assessing their relative value. He explains the difference between eating them vs. drinking them, how processing fruits and vegetables can change their properties, and how one’s current state of health affects nutrition strategy when it comes to fruits and vegetable consumption. Additionally, Peter explains the potential benefits and negative effects of certain phytochemicals found in produce and concludes with a discussion of supplementing with green powders, multivitamins, and more.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #36 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

The limitations of nutritional data and challenges of making broad recommendations [2:00];
How one’s current state of health impacts their “optimal” diet [11:30];
Defining “metabolic health” [14:45];
The wide-ranging nutrition profiles of various fruits and vegetables [16:30];
The benefits of fiber [20:45];
Eating whole fruits vs. drinking fruit juice or smoothies [22:30];
Drinking alcohol: metabolic effects, calories in alcohol, and more [28:30];
Can excess fruit consumption lead to insulin resistance? [30:30];
Glycemic impact of different fruits, using CGM data to assist decision making, and how fruit is fundamentally different from what we evolved to eat [31:30];
Dietary approaches for people with a carbohydrate tolerance disorder (TD2, NAFLD, etc.), and when it makes sense to restrict fruit consumption [34:30];
Nutrition profile of select vegetables: sugar content, micronutrients, and more [40:00];
Phytochemicals in produce: potential positive health impacts on inflammation, cardiovascular (CV) risk, and cancer [44:30];
Phytochemicals with potential negative health impacts [50:45];
Nightshades and inflammation [53:15];
How important is it to eat organic foods? [56:00];
How necessary is it to wash fruits and vegetables? [1:00:45];
How does food preparation change the nutritional composition? [1:03:45];
Considerations when eating canned and frozen food, and paying attention to processed food additives [1:04:45];
Supplementing vitamins and nutrients as an alternative to eating whole fruits and vegetables [1:06:15];
Green powder supplements [1:11:15];
Important takeaways [1:16:00]; and
More.

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#210 - Lp(a) and its impact on heart disease | Benoît Arsenault, Ph.D. Jun 13, 2022

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Benoît Arsenault is a research scientist focused on understanding how lifestyle and genetic factors contribute to cardiovascular disease risk. In this episode, the discussion casts a spotlight on Lp(a)—the single most important genetically-inherited trait when it comes to atherosclerotic cardiovascular disease (ASCVD) risk. Benoît explains the biology of Lp(a), how it’s inherited, the importance of measuring Lp(a) levels, and the diseases most associated with high Lp(a). He dives into data on the possible treatments for lowering Lp(a) such niacin, statins, and PCSK9 inhibitors, as well as the most exciting new potential therapeutic—antisense oligonucleotides.

We discuss:

How Benoît came to study Lp(a)—a new marker for cardiovascular risk [3:15];
The relationship between Lp(a) and CVD risk [6:45];
What genome-wide association studies (GWAS) revealed about Lp(a) [16:00];
Clinical tests to measure Lp(a) [22:00];
The biology of Lp(a) [25:45];
How statins lower LDL-cholesterol and why this doesn't work for an Lp(a) [29:15];
The structure of LDL-p and Lp(a) and what makes Lp(a) more atherogenic than an equivalent LDL particle [34:00];
The role of Lp(a) in aortic valve disease [42:45];
How greater numbers of Lp(a) particles are associated with increased risk of disease [48:00];
The genetics and inheritance of Lp(a) and how and when to measure Lp(a) levels [52:00];
Niacin and other proposed therapies to lower Lp(a), apoB, and CVD risk [1:00:45];
Why awareness of Lp(a) among physicians remains low despite the importance of managing risk factors for ASCVD [1:14:00];
The variability of disease in patients with high Lp(a) [1:19:00];
Diseases most associated with high Lp(a) [1:26:30];
The biology of PCSK9 protein, familial hypercholesterolemia, and the case for inhibiting PCSK9 [1:35:00];
The variability in PCSK9 inhibitors’ ability to lower Lp(a) and why we need more research on individuals with high levels of Lp(a) [1:50:30];
Peter’s approach to managing patients with high Lp(a), and Benoît’s personal approach to managing his risk [1:54:45];
Antisense oligonucleotides—a potential new therapeutic for Lp(a) [1:57:15]; and
More.

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#209 ‒ Medical mistakes, patient safety, and the RaDonda Vaught case | Marty Makary, M.D., M.P.H. Jun 06, 2022

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Marty Makary is a surgeon, public policy researcher, and author of the New York times best-sellers Unaccountable and The Price We Pay. In this episode, Marty dives deep into the topic of patient safety. He describes the risk of medical errors that patients face when they walk into the hospital and how those errors take place, and he highlights what amounts to an epidemic of medical mistakes. He explains how the culture of patient safety has advanced in recent decades, the specific improvements driven by a patient safety movement, and what’s holding back further progress. The second half of this episode discusses the high-profile case of RaDonda Vaught, a nurse at Vanderbilt Hospital convicted of negligent homicide after she mistakenly gave a patient the wrong medication in 2017. He discusses the fallout from this case and how it has in some ways unraveled decades of progress in patient safety. Furthermore, Marty provides insights in how to advocate for a loved one in the hospital, details the changes needed to meaningfully reduce the death rate from medical errors, and provides a hopeful vision for future improvements to patient safety.

We discuss:

Brief history of patient safety, preventable medical mistakes, and catalysts for major changes to patient safety protocols [0:12];
Advancements in patient safety and the dramatic reduction in central line infections [14:55];
A surgical safety checklist—a major milestone in patient safety [23:03];
A tragic case stimulates a culture of speaking up about concerns among surgical teams [25:19];
Studies showing the ubiquitous nature of medical mistakes leading to patient death [29:42];
The medical mistake of over-prescribing of opioids [33:48];
Other types of errors—electronic medical records, nosocomial infections, and more [35:43];
Importance of honesty from physicians and what really drives malpractice claims [40:26];
A high-profile medical mistake case involving nurse RaDonda Vaught [47:31];
Investigations leading to the arrest of RaDonda Vaught [59:48];
Vaught’s trial—a charge of “negligent homicide” [1:05:16];
A guilty charge and an outpouring of support for Vaught [1:12:09];
Concerns from the nursing profession over the RaDonda Vaught conviction [1:18:09];
How to advocate for a friend or family member in the hospital [1:20:22];
Changes needed for meaningful reduction in the death rate from medical errors [1:26:42];
Blind spots in our current national funding mechanism and the need for more research into patient safety [1:31:42];
Parting thoughts—where do we go from here? [1:35:48];
More.

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The Art of Stability | Beth Lewis (Ep. #131 Rebroadcast) May 30, 2022

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Beth Lewis is a former professional dancer and a self-described “educator of movement” who has an unmatched ability to assimilate information and customize training plans from multiple training systems. In this episode, Beth describes how she identifies problematic movement patterns and postures to help individuals relieve pain, avoid injury, and move better within all types of exercise. She explains how movement is a trainable skill and provides suggestions for ways that people can modify or supplement their exercise routine to benefit their health and longevity.

We discuss:

Beth’s “way of no way” training philosophy [2:15]
Beth’s background in dancing and how she ended up in New York City [5:00]
Beth’s transition to fitness coaching and how her training philosophy has evolved [10:15];
Functional Range Conditioning and scapular mobility [19:20];
An overview of the Postural Restoration Institute, and Peter’s squat assessment [33:00];
The important connection between the ribs and breathing [37:15];
The role of sitting and external stress in chronic muscular tension [40:00];
The important role of your toes, minimalist footwear, and toe yoga [42:00];
Dynamic Neuromuscular Stabilization (DNS) [46:00];
A different view on knee valgus [50:15];
Is there such a thing as “bad posture”? [54:00];
How Beth identifies an issue, addresses it, and keeps clients motivated [56:15];
Lifting weights, the Centenarian Olympics, and dancing into old age [1:08:30];
The importance of the hamstrings versus abs [1:18:45];
Benefits of rowing, and why everyone should add it to their exercise regimen [1:24:45]
Different roles of concentric versus eccentric strength [1:32:45];
Flexibility and high-intensity interval training (HIIT) [1:37:10];
Training versus playing sports, and the best type of activity for kids [1:40:30]; and
More.

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#208 - Tragedy, grief, healing, and finding happiness | Kelsey Chittick May 23, 2022

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Kelsey Chittick is the author of Second Half: Surviving Loss and Finding Magic in the Missing. In this episode, Kelsey describes her long healing process following the sudden death of her husband, former NFL player Nate Hobgood-Chittick. She describes her life with Nate before and after football, including her premonitions that something was off about Nate and the subsequent finding that he suffered from chronic traumatic encephalopathy (CTE). She speaks openly about how she handled his death with her children, the trauma and grief they faced in the aftermath, and how she’s found ways to be happy in her new life. She shares deep insights into her healing process, including her experience with psychedelics and how the concept of “radical acceptance” has helped her to find joy once again.

We discuss:

Kelsey’s childhood in Florida as an athlete [2:15];
Meeting Nate and early relationship with him [7:45];
Nate’s unbelievable work ethic and desire to play in the NFL [12:30];
Life with a professional football player, playing through pain, and head injuries related to football [17:00];
Nate’s final days of football and early retirement struggles [23:30];
The tough transition from the NFL to a “regular life” and how Nate found a way to serve others [28:45];
Nate’s struggle with his weight and overall health after retirement [34:45];
Kelsey’s anxiety and premonitions of Nate’s impending death, and Nate’s changing demeanor [37:30];
The traumatic experience of learning of Nate’s death during her own spiritual journey to Jamaica [45:30];
Breaking the news to her children of their father’s death [51:00];
The darkest days following Nate’s passing and how her children were handling grief [55:30];
A new relationship with death, finding happiness, and the duality of feelings [1:02:45];
Nate’s autopsy results showing evidence of CTE [1:07:00];
The grieving process [1:15:00];
Dealing with grief with kids and how children grieve differently [1:19:15];
Healing through her first psychedelic experience [1:23:00];
The therapeutic potential of psychedelics, meditation, and more [1:33:45];
The concept of “radical acceptance” and the peace that comes with it [1:42:30];
The up and down experience of writing her book [1:47:45];
More.

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#207 - AMA #35: "Anti-Aging" Drugs — NAD+, metformin, & rapamycin May 16, 2022

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In this “Ask Me Anything” (AMA) episode, Peter is joined by special guest, Dr. Matt Kaeberlein. Together they answer many questions around the field of aging with an emphasis on three specific molecules—NAD, metformin, and rapamycin—and their purported geroprotective qualities. They first discuss aging biomarkers and epigenetic clocks before breaking down the advantages and limitations of the most common experimental models being used today to study aging and pharmacological possibilities for extending lifespan. Next they dive deep into NAD and the much-hyped NAD precursors, nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN). They compare data from NAD precursors to studies on metformin and rapamycin, assessing how they stack up against each other and using the comparison as an opportunity to illustrate how to make sense of new experimental data and make smart decisions about how to approach future research.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #35 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Logic behind comparing NAD precursors to rapamycin and metformin [3:40];
Aging biomarkers: current state, usefulness, and future promise [7:00];
Epigenetic clocks: definition, use case, and limitations [14:45];
Advantages and limitations of studying aging in non-humans and the strengths and weaknesses of different model systems [26:30];
Aging studies: importance of control lifespans and the problems with reproducibility [34:15];
Intro to NAD, potential role in aging, relationship to sirtuins, and more [48:15];
NAD precursors (NR and NMN): current data [1:10:00];
Human studies with NAD precursors [1:25:45];
Comparing NAD lifespan data to data from metformin and rapamycin [1:28:30];
Defining a “clean drug” and a “dirty drug” [1:38:00];
Reason for the lack of rapamycin studies in humans compared to NAD and metformin [1:41:00];
Ranking the geroprotective molecules in terms of risk and reward [1:48:00]; and
More.

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#206 - Exercising for longevity: strength, stability, zone 2, zone 5, and more May 09, 2022

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In this special episode of The Drive, we have pulled together a variety of clips from previous podcasts about exercise to help listeners understand this topic more deeply, as well as to identify previous episodes which may be of interest. In this episode, Peter discusses his framework for exercise, what he’s really optimizing for, and how to train today to be prepared for a good life at age 100. He describes the importance of strength and stability, and why deadlifting is an important tool to consider for longevity. Additionally, he details why training in zone 2 and zone 5 is important, gives a primer on VO2 max, and describes the most effective ways to engage in those types of exercise. Finally, Peter reveals his current exercise routine.

We discuss:

What is Peter optimizing for with his exercise? [3:00];
Preparing for a good life at age 100: Training for the “Centenarian Olympics” [6:00];
The importance of preserving strength and muscle mass as we age [21:45];
The value of deadlifts for stability and longevity when done properly [27:30];
The importance of zone 2 aerobic training [35:45];
The most effective ways to engage in zone 2 exercise [40:00];
Zone 5 training and VO2 max [44:15];
A primer on VO2 max [52:00];
Stability—the cornerstone upon which all exercise and movement relies [1:03:00];
Peter’s current exercise routine [1:07:45];
More.

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#205 - Energy balance, nutrition, & building muscle | Layne Norton, Ph.D. (Pt.2) May 02, 2022

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Layne Norton holds a Ph.D. in nutritional sciences and is a physique coach, natural bodybuilder, and previous guest on The Drive. In the first half of this episode, Layne dives deep into the topic of energy balance, including the role that macronutrients and calories play in weight loss. He describes how many people struggle with tracking food and calories on their own across a variety of diets and how all of this can impact nutritional habits and behaviors. In the second half of the episode, Layne discusses the importance of protein and weightlifting for improving one’s body composition and increasing muscle mass. He explains how he would prescribe different training and nutrition programs for two hypothetical clients—a 50-year-old female who is entering menopause and wants to improve her health, and a 40-to-50-year-old male who wants to maximize muscle mass. Additionally, Layne discusses a number of supplements that could potentially benefit a training program including whey protein, branch chain amino acids, creatine, nitric oxide boosters, and more.

We discuss:

Defining energy balance and the role of calories [2:30];
Defining a calorie, whether they are all created equal, and how much energy you can extract from the food you eat [8:00];
Factors influencing total daily energy expenditure [12:15]:
The challenge of tracking energy expenditure accurately, and the thermic effect of different macronutrients [23:30];
Challenges of sustained weight loss: metabolic adaptation, set points, and more [34:45];
Weight loss strategies: tracking calories, cheat meals, snacks, fasting, exercise, and more [40:45];
Sitting in discomfort, focusing on habits, and other lessons Layne learned as a natural bodybuilder [52:15];
Commonalities in people who maintain long-term weight-loss [1:01:15];
Does a ketogenic diet result in greater energy expenditure? [1:03:15];
The metabolic benefits of exercise, muscle mass, and protein intake [1:15:00];
The impact of lean muscle and strength on lifespan and healthspan [1:20:00];
Hypothetical case study #1: Training program for 50-year-old female [1:27:45];
Muscle protein synthesis in a trained athlete vs. untrained individual following a resistance training program [1:31:30];
Protein and amino acids needed to build and maintain muscle mass [1:37:15];
Nutrition plan for the hypothetical 50-year-old woman starting to build lean muscle [1:42:45];
Dispelling myths that excess protein intake increases cancer risk through elevations in mTOR and IGF [1:55:30];
Hypothetical case study #2: Training program for a 50-year-old, trained male wanting to increase muscle mass [2:04:00];
Maximizing hypertrophy while minimizing fatigue—is it necessary to train to muscular failure? [2:11:30];
Ideal sets and reps for the hypothetical 50-year-old male interested in hypertrophy [2:16:15];
Maximizing hypertrophy by working a muscle at a long muscle length [2:22:15];
Recommended lower body exercise routines and tips about training frequency [2:24:00];
Nutrition plan for the hypothetical 50-year old male wanting to add muscle [2:29:00];
Cycling weight gain and weight loss when building lean muscle mass, and expectations for progress over time [2:33:30];
Supplements to aid in hypertrophy training [2:38:30];
More.

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#204 - Centenarians, metformin, and longevity | Nir Barzilai, M.D. Apr 25, 2022

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Nir Barzilai, Director of the Institute for Aging Research at the Albert Einstein College of Medicine, is back for his third appearance on The Drive. In this episode, Nir divulges insights into lifespan and healthspan through the lens of his extensive research on centenarians as well as the latest from the TAME trial (Targeting/Taming Aging with Metformin), a multi-center study investigating the concept that the multi-morbidities of aging can be delayed in humans. He discusses common gene variants found in centenarians, important pathways for longevity, and ultimately what we can learn from centenarians about extending lifespan while also trying to improve healthspan. Additionally, Nir goes into depth on metformin as a longevity tool for humans, including studies with positive and negative results. He discusses the impact metformin can have on exercise for both strength training and cardiovascular training, as well as future research facilitated by data from the TAME Trial. He also touches on epigenetic clocks and concludes with his take on the usefulness of NAD precursors as a potential gero-protective agent.

We discuss:

Insights from genetic studies of centenarians and twins [3:00];
Genes with protective variants that aid longevity [13:00];
The relationship between growth hormone and IGF-1 [22:45];
Use of growth hormone as a longevity tool [34:00];
Longevity genotypes: the role of APOE e2, Lp(a), Klotho, and CETP [41:45];
The correlation between high TSH and longevity [46:30];
Important pathways for longevity [52:00];
Insights from centenarian studies, nature vs. nurture, and more [59:00];
The contraction of morbidity that comes with improved healthspan [1:08:00];
Defining healthspan [1:13:13];
Unique perspectives and positive attitudes of centenarians [1:17:30];
Lessons to take away from centenarians [1:24:00];
Metformin overview: history, studies, and potential for gero-protection [1:28:45];
The TAME trial (Targeting Aging with Metformin) [1:39:00];
The challenge of studying metformin in animals models [1:46:45];
How data from the TAME trial could provide insights into biomarkers of aging and facilitate a future study on proteomics [1:53:30];
The search for biomarkers to identify who can benefit from treatment [2:00:30];
The impact of metformin on exercise, and finding the right indication for the use of metformin [2:10:30];
Are NAD precursors geroprotective? [2:21:30]; and
More.

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#203 - AMA #34: What Causes Heart Disease? Apr 18, 2022

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In this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of atherosclerotic cardiovascular disease (ASCVD)—the number one killer in the developed world. Peter argues for the importance of paying attention to and understanding ASCVD given its ubiquity and inevitability. He goes into great detail about the development of atherosclerosis and how it can take hold at a very early age, the role of cholesterol, and the causal factors of ASCVD that determine prevention strategies. Additionally, he discusses the important metrics and biomarkers found in blood work, as well as diagnostic tests such as coronary artery calcium scores (CAC) and CT angiograms which help to determine the level of arterial damage present. Finally, Peter lays out the keys to understanding and interpreting calcium scores before wrapping up the conversation with his key takeaways regarding prevention.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #34 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

The importance of understanding atherosclerosis early in life [2:15];
Defining atherosclerotic cardiovascular disease (ASCVD), its causes, and the role of cholesterol [9:00];
The process of developing ASCVD, part 1 [15:00];
The process of developing ASCVD, part 2 [24:00];
The process of developing ASCVD, part 3 [32:45];
How early in life ASCVD can start to develop [40:30];
Case studies of atherosclerosis and figures showing real pathology [43:00];
Coronary artery lesions present in autopsies of different age groups [49:15];
The causal factors of ASCVD that determine prevention strategies [52:15];
Labs to identify biomarkers of ASCVD ]59:00];
Diagnostic tests to determine the level of arterial damage present—CAC, CTA, CIMT, and more [1:00:30]
Keys to understanding and interpreting a CAC score and/or CTA results [1:05:15];
Is there a risk from cholesterol levels being too low? [1:13:00];
Key takeaways regarding prevention [1:15:45];
More.

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#202 - Peter on nutrition, disease prevention, sleep, and more — looking back on the last 100 episodes Apr 11, 2022

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In this second edition of the “Strong Convictions, Loosely Held” episode, Peter discusses topics on which his thoughts have evolved as a result of his interviews with podcast guests and other information he’s gained since episode 100. Peter covers topics including cancer therapy and screening, as well as prevention strategies for cardiovascular disease and Alzheimer’s disease. He also describes changes in his perspectives on time-restricted feeding and protein consumption and on the therapeutic use of psychedelics, and he discusses some sleep supplements with remarkable efficacy. He ends with a special discussion on all things Formula 1 racing.

We discuss:

The concept of “strong convictions, loosely held” [3:10];
Update on Peter’s upcoming book [8:30];
Cancer: the promise of immunotherapy [14:15];
Cancer: how aggressive screening for gastrointestinal cancers could save lives [24:30];
Cardiovascular disease: how early and aggressive lowering of apoB could change the course of ASCVD [31:30];
Alzheimer’s disease: genes that modify risk associated with the APOE4 variant [40:15];
Time-restricted feeding: where the benefit comes from, and when this practice can be problematic [44:00];
The common problem of protein underconsumption [51:45];
The tremendous impact of exercise on lifespan and healthspan [54:45];
Peter’s shoulder surgery [1:00:15];
An uninspiring viewpoint on NAD precursors as a longevity tool [1:06:15];
Psychedelics: a powerful therapeutic tool in the right setting [1:09:30];
Sleep: updated thoughts on blue light and a remarkable drug for aiding sleep quality [1:13:15];
Book recommendation from Peter [1:20:45];
Formula 1: the 5 variables that determine the winner [1:22:00];
F1: the drivers [1:26:00];
F1: the tires [1:27:30];
F1: the engine and chassis [1:32:00];
F1: rule changes around cars [1:34:15];
F1: importance of qualifying races [1:41:15];
F1: racing strategy [1:47:30];
F1: season outlook and predictions [1:51:00]; and
More.

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In remembrance of Sarah Hallberg, D.O., M.S. (Ep. #162 Rebroadcast) Apr 04, 2022

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Episode Description:

Today’s episode of The Drive is a rebroadcast of the conversation with Sarah Hallberg (released on May 17th, 2021). It's with great sadness that we report that Sarah recently lost her battle with lung cancer, and as such we've decided to republish her episode to honor her amazing work in challenging the status quo in the treatment of metabolic disease.

Sarah Hallberg was the Medical Director at Virta Health and a physician who spent nearly two decades treating patients with obesity and type 2 diabetes. In the first half of this episode, Sarah discusses how she became a huge believer in the efficacy of carbohydrate restriction for the treatment of type 2 diabetes through her research and clinical experience. Sarah challenges the common beliefs about the role of dietary fat and carbohydrate on the plasma makeup of fatty acids and triglycerides. She also expresses the importance of understanding early predictors of metabolic illness—highlighting one particular fatty acid as the most important early predictor—before finishing with a discussion about how doctors might be able to personalize patients’ metabolic management in the future. In the second half of this episode, Sarah tells the personal story of her own lung cancer diagnosis. She talks about dealing with her grief, deciding to continue her work while prioritizing her family, and how she devised a plan to extend her survival as long as possible.

We discuss:

How Sarah discovered the profound impact of carbohydrate restriction for reversing obesity and type 2 diabetes [2:00];
Prediabetes and metabolic syndrome: prevalence, early signs, and the importance of treating early [14:45];
Overview of fatty acids, how they are metabolized, and understanding what you see in a standard blood panel [28:00];
The relationship between diet composition and metabolic markers [34:00];
Why palmitoleic acid is such an important biomarker [47:00];
The best early indicators of metabolic disease [58:45];
Personalized management of metabolic illness [1:05:45];
Sarah’s cancer diagnosis and the beginning of her journey [1:14:00];
The emotional impact of a devastating diagnosis [1:26:00];
Sarah’s plan to extend survival [1:35:30];
Sarah’s aggressive treatment plan [1:46:15];
Life-threatening complications and the return of her cancer [1:57:45];
Sarah’s reflections on her approach to life with chronic cancer and balancing her time [2:09:45]; and
More.

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#201 - Deep dive back into Zone 2 | Iñigo San-Millán, Ph.D. (Pt. 2) Mar 28, 2022

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Episode Description:

Iñigo San-Millán is an internationally renowned applied physiologist and a previous guest on The Drive. His research and clinical work focuses on exercise-related metabolism, metabolic health, diabetes, cancer metabolism, nutrition, sports performance, and critical care. In this episode, Iñigo describes how his work with Tour de France winner Tadej Pogačar has provided insights into the amazing potential of elite athletes from a performance and metabolic perspective. He speaks specifically about lactate levels, fat oxidation, how carbohydrates in food can affect our lactate and how equal lactate outputs between an athlete and a metabolically unhealthy individual can mean different things. Next, he discusses how Zone 2 training boosts mitochondrial function and impacts longevity. He explains the different metrics for assessing one’s Zone 2 threshold and describes the optimal dose, frequency, duration, and type of exercise for Zone 2. Additionally, he offers his thoughts on how to incorporate high intensity training (Zone 5) to optimize health, as well as the potential of metformin and NAD to boost mitochondrial health. Finally, he discusses insights he’s gathered from studying the mitochondria of long COVID patients in the ICU.

We discuss:

The amazing potential of cyclist Tadej Pogačar [3:00];
Metrics for assessing athletic performance in cyclists and how that impacts race strategy [8:30];
The impact of performance-enhancing drugs and the potential for transparency into athletes’ data during competition [17:00];
Tadej Pogačar’s race strategy and mindset at the Tour de France [24:00];
Defining Zone 2, fat oxidation, and how they are measured [26:45];
Using fat and carbohydrate utilization to calculate mitochondrial function and metabolic flexibility [35:45];
Lactate levels and fat oxidation as it relates to Zone 2 exercise [40:00];
How moderately active individuals should train to improve metabolic function and maximize mitochondrial performance [51:45];
Bioenergetics of the cell and what is different in elite athletes [57:30];
How the level of carbohydrate in the diet affects fuel utilization and power output during exercise [1:08:30];
Glutamine as a source for making glycogen—insights from studying the altered metabolism of ICU patients [1:15:00];
How exercise mobilizes glucose transporters—an important factor in diabetic patients [1:21:00];
Metrics for finding Zone 2 threshold—lactate, heart rate, and more [1:25:00];
Optimal Zone 2 training: dose, frequency, duration, and type of exercise [1:41:15];
How to incorporate high intensity training (Zone 5) to increase VO2 max and optimize fitness [1:51:15];
Compounding benefits of Zone 2 exercise and how we can improve metabolic health into old age [2:01:45];
The effects of metformin, NAD, and supplements on mitochondrial function [2:05:15];
The role of lactate and exercise in cancer [2:13:30];
How assessing metabolic parameters in long COVID patients provides insights into this disease [2:19:00];
The advantages of using cellular surrogates of metabolism instead of VO2 max for prescribing exercise [2:25:45];
Metabolomics reveals how cellular metabolism is altered in sedentary individuals [2:33:45];
Cellular changes in the metabolism of people with diabetes and metabolic syndrome [2:39:15]; and
More.

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#200 - AMA #33: Hydration—electrolytes, supplements, sports drinks, performance effects, and more Mar 21, 2022

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Episode Description:

In this “Ask Me Anything” (AMA) episode, Peter discusses all things related to hydration, starting with how water is distributed in the body and the important concept of tonicity. He explains the difference between dehydration and volume depletion and their respective health consequences and implications. He describes the different conditions which affect our daily water needs, as well as the signs of dehydration and how it can affect performance. Next, he discusses all the ways in which we can rehydrate and when it makes sense to add electrolytes, glucose—or a combination of both—to rehydration fluids. Additionally, Peter gives his take on the plethora of sports drinks on the market and which ones stand out from the rest. Finally, he concludes with some key takeaways related to hydration.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #33 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Peter’s incident leading to a renewed interest in hydration [3:15];
Water in the human body: percentage, location, and implications [6:00];
Defining tonicity—isotonic, hypotonic, and hypertonic [11:45];
Defining dehydration and volume depletion [19:00];
The health consequences of dehydration and volume depletion [21:45];
How do we actually lose water? [25:30];
How much water do we need every day? [28:00];
Signs of dehydration during exercise and how it can affect performance [32:45];
Is it possible to be overhydrated? [43:15];
Electrolytes: benefits and when to include them in rehydration fluids [47:00];
Glucose: benefits and when to include it in rehydration fluids 51:15];
The ability of glucose to improve absorption of sodium [58:45];
The type of carbohydrates in drinks than actually impact performance [1:02:00];
Sodium during workouts: is there an optimal ratio of carbohydrate to sodium? [1:05:00];
Pros and cons of sports drinks and which ones stand out [1:09:15];
How much hydration comes from the food we eat? [1:14:30];
Is there a downside to drinking electrolytes throughout the day even without exercise? [1:15:15];
Key takeaways related to hydration [1:18:15]; and
More.

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#199 - Running, overcoming challenges, and finding success | Ryan Hall Mar 14, 2022

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Episode Description:

Ryan Hall is the fastest American ever to run the marathon (2:04:58) and half marathon (59:43) and is the author of the book Run the Mile You’re In. In this episode, Ryan discusses his amazing successes and epic failures during his remarkable running career and what he's learned through these experiences. Ryan explains not only the physical aspects of running - including his training routine, fueling regimen, and recovery process - but he also emphasizes the mental aspect of the sport. He discusses how accepting and reframing negative thoughts can empower you to take on challenges and reach your potential. Additionally, Ryan discusses the traits that make the best competitors, the keys to overcoming setbacks, and his amazing feat of 7 marathons in 7 days as a goodbye to the sport that gave him so much.

We discuss:

How Ryan got into running and his formative years of training [4:45];
The advantages of altitude—living high and training low [9:45];
Progressive overload, blood flow restriction, and switching up your workout routine [14:15];
Lessons learned from competing in the Beijing Olympics [16:45];
Importance of speed, power, and strength for runners [22:15];
The crazy idea that got Ryan hooked on running [35:15];
The mental aspect of training and the power of reframing negative thoughts [37:45];
The importance of fueling, and Ryan’s marathon diet [52:00];
Boosting performance with Tylenol and keeping core temperature down [59:00];
Ryan’s early struggles and later success at Stanford [1:09:45];
Keys to overcoming difficulty: faith, mindset, and being a better teammate [1:15:45];
Ryan’s professional running career and his discovery of his gift for marathon distances [1:22:00];
Reflections after breaking the American half marathon record, and challenges faced by retired athletes [1:32:45];
Ryan’s marathon training regimen at the Mammoth Track Club in 2010 [1:39:45];
Optimal body weight for competition and the pros and cons of going below your natural weight [1:48:45];
Training volume, importance of mixing up intensity level, and zone 2 and zone 5 for longevity [1:53:45];
The most impactful adjustments Ryan made to his training leading up the to 2011 Boston Marathon [1:58:15];
A new personal record at the 2011 Boston Marathon and lessons on maximizing your own potential [2:03:30];
Learning from failure and takeaways from his disappointing performance at the 2012 Olympics [2:12:30];
Utilizing cardio and strength training for overall health, and how Ryan uses blood flow restriction in his workouts [2:24:45];
Performance enhancing drugs (or lack thereof) in marathon runners [2:29:15];
Traits of the greatest marathon runners [2:32:30];
7 marathons in 7 days on 7 continents—saying goodbye to the sport [2:38:45];
Reflections on what running has given Ryan [2:49:30]; and
More.

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#198 - Eye health—everything you need to know | Steven Dell, M.D. Mar 07, 2022

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Episode Description:

Steven Dell is an ophthalmologist, current Medical Director of Dell Laser Consultants, and a leader in refractive eye surgery with over 20 patents to his name. In this episode, Steven explains the anatomy and functional mechanics of the eye and how they relate to common variations in vision. He discusses changes in vision that occur with aging, the fundamentals of different types of vision loss, and provides an in-depth look into the various treatments and procedures available for corrective eye surgery. Additionally, Steven explains how one might protect the eyes and prevent vision loss—a topic particularly important for children in light of the epidemic of myopia.

We discuss:

Why Steven chose ophthalmology, and the crossovers to other medical disciplines [3:45];
Anatomy of the eye, common types of vision loss, and age-related vision changes [14:15];
Eye drops that can potentially improve vision [27:30];
The explanation for different eye colors [33:15];
Physiology of the eye and its connections to the brain [34:45];
Understanding human vision through an evolutionary lens [41:00];
Enhancing vision beyond 20/20 [47:00];
Astigmatism: definition, cause, and high prevalence [51:30];
Nearsightedness (myopia): causes, epidemic in children, and prevention strategies [54:15];
Cataracts: impact of aging and how they can be repaired [1:05:00];
Lens implants that can correct and improve vision [1:19:30];
Effects of eye trauma [1:26:45];
Corneal abrasion from ‘dry eye’: causes, treatment, and prevention strategies [1:29:00];
Sunglasses for eye protection [1:35:00];
Solutions to correct nearsightedness [1:42:00];
Laser eye surgery—photorefractive keratectomy (PRK) [1:45:45];
Laser eye surgery—LASIK [2:02:00];
Laser eye surgery—small incision lenticule extraction (SMILE) [2:11:45];
Glaucoma: definition, causes, symptoms, and care [2:13:45];
Tips for preserving eye health [2:20:00];
Screen time and eye health [2:24:15];
Contact lenses: good hygiene and considerations [2:27:45];
A bonus benefit from repairing cataracts [2:29:00];
Questions about corrective eye surgery [2:31:30];
How an eye exam can be a window into metabolic illness [2:33:45]; and
More.

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#197 - The science of obesity & how to improve nutritional epidemiology | David Allison, Ph.D. Feb 28, 2022

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Episode Description:

David Allison is an award-winning scientific writer who has been at the forefront of obesity research for the last 20 years. Currently the Dean of the Indiana University School of Public Health, he has also authored many publications on statistical and research methodology and how to improve research rigor and integrity. David’s focus on evidence and data brings forth an interesting discussion of what we know (and don’t know) about the science of obesity. He provides an insightful and unemotional explanation of the potential impact of nutritional epidemiology in public health while also explaining its many pitfalls and limitations. He offers his take on the path forward in addressing the obesity epidemic, and he closes with a lucid explanation for the evident lack of credibility in science and the steps we can take to change that.

We discuss:

David’s background, interest in obesity, and focus on evidence [5:00];
The moment when the obesity crisis was recognized, and the sloppy science that ensued [13:00];
What twins studies tell us about the genetics of obesity [20:30];
How doctors and scientists have historically approached obesity treatment [23:45];
Do surgical procedures for obesity prolong life? [32:00];
The ‘Obesity Paradox’ [36:00];
Interpreting BMI and mortality data and considering confounders [43:15];
How body composition and ethnicity factor into consideration of BMI data [50:30];
Superior tools for measuring obesity at the individual level [57:15];
Using BMI data for actionable steps to combat obesity [1:02:00];
Why maintaining weight loss is more challenging than losing weight [1:06:00];
Differing perspectives on the utility of nutritional epidemiology [1:16:30];
A mouse study illustrating the impossibility of fully controlling for confounds in observational studies [1:22:15];
Limitations of nutritional epidemiology and how it can improve [1:26:30];
Addressing the obesity epidemic—the path forward and obstacles to overcome [1:37:15];
What David believes to be the most promising interventions we could take to address obesity and improve public health [1:47:30];
Reproducibility in science, normative and non-normative errors explained [1:51:30];
Rebuilding trust in science and differentiating between science and advocacy [1:59:00];
More.

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#196 - AMA #32: Exercise, squats, deadlifts, BFR, and TRT Feb 21, 2022

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Episode Description:

In this “Ask Me Anything” (AMA) episode, Peter shares his current workout regimen and how he incorporates blood flow restriction (BFR). He walks through the mechanics and fundamentals of some of his favorite lifts including squats, deadlifts, and hip thrusters and stresses the relative importance of each in the context of longevity. He touches on the relative importance of muscle size vs. muscle strength and discusses the impact of fasting on muscle mass and the potential tradeoffs during aging. Peter then dives into the topic of testosterone replacement therapy (TRT) for both men and women, starting with a clinical discussion around how he actually replaces testosterone in patients. He explains the targets of this therapy as well as the risks and benefits, and he gives his interpretation of current data on the association between TRT and heart disease.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA#32 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Peter’s current exercise routine [2:25];
How Peter incorporates blood flow restriction (BFR) into his workouts [5:45];
Relative importance of muscle size vs. muscle strength [16:45];
Comparing squats to deadlifts and why both are important [22:00];
Squatting technique and fundamentals [31:15];
Important cues to look for while lifting weights [38:30];
Proper mechanics of a deadlift [42:00];
Hip thrusters as an alternative to the squat or deadlift [44:00];
Split-leg work for simulating activities of daily living [47:00];
The impact of fasting/calorie restriction on muscle mass and the potential tradeoffs to consider [49:45];
Testosterone replacement therapy: considerations when contemplating TRT and Peter’s approach with patents [54:30];
Data on the association between TRT and heart disease [1:04:15];
TRT for women—risks and benefits [1:06:45];
Impact of fasting on testosterone levels [1:13:45]; and
More.

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#195 - Freedom, PTSD, war, and life through an evolutionary lens | Sebastian Junger Feb 14, 2022

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Episode Description:

Sebastian Junger is an award-winning journalist, documentary filmmaker, and New York Times best-selling author. In this wide-ranging discussion, Sebastian shares stories from his time as a war reporter and how it shaped his understanding of the psychological effects of combat, including the sacred bond of soldiers, the forces that unify a tribe, and the psychological mechanisms that protect humans from painful experiences. He draws upon his personal struggle with PTSD as he discusses trauma as an all-too-common consequence of war and the importance of community in the healing process. He explains his interest in viewing human behavior through an evolutionary lens, including how it influences his parenting style, and he voices concerns over society’s continuous shift away from our evolutionary roots. Sebastian also tells the story of his near-death experience and his new perspective on the possibility of an afterlife. Additionally, Sebastian shares his thoughts on the mental health implications of current events, such as the pandemic and the withdrawal of troops from Afghanistan, and contemplates what it really means to be “free” in modern society.

We discuss:

Sebastian’s upbringing and early lessons about the evil of fascism [3:20];
Sebastian’s search for a career, interest in writing, and what he loved about tree removal [11:30];
How Sebastian became a great writer [19:30];
Sebastian’s experience with his Achilles injuries [25:30];
Work as a war reporter and his experience in combat in Afghanistan [28:00];
Psychological effects of war and Sebastian’s own experience with PTSD [36:30];
The sacred bond of soldiers and what Sebastian learned from his time with troops in Afghanistan [48:30];
An evolutionary perspective on the forces that unify and bind tribes [1:00:00];
Hunter-gatherer societies, dealing with loss, and the ancestral connection to the spiritual realm [1:08:30];
Psychological mechanisms that protect humans from painful experiences and the power in giving thanks [1:13:15];
How parenting has changed Sebastian, and the incredible pain of losing a child [1:21:15];
PTSD and the influence of community on healing [1:32:15];
Isolation of modern society and the debate over young kids sleeping in bed with their parents [1:37:45];
Why Sebastian doesn’t own a smartphone [1:43:30];
Parenting through an evolutionary lens [1:50:00];
Sebastian’s near-death experience and new perspective on the possibility of an afterlife [1:54:00];
Sebastian’s experience with depression and anxiety [2:12:00];
The pandemic’s impact on mental health [2:16:45];
Sebastian’s thoughts on the withdrawal of troops from Afghanistan [2:22:00];
Sebastian’s latest book—Freedom, and knowing when to quit [2:27:00];
Defining freedom in modern society [2:44:30];
More.

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#194 - How fructose drives metabolic disease | Rick Johnson, M.D. Feb 07, 2022

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Episode Description:

Rick Johnson, Professor of Nephrology at the University of Colorado and a previous guest on The Drive, returns for a follow-up about unique features of fructose metabolism, and how this system that aided the survival of human ancestors has become potentially hazardous based on our culture’s dietary norms. In this episode, Rick explains how the body can generate fructose from glucose and how circulating glucose and salt levels can activate this conversion. He discusses the decline in metabolic flexibility associated with aging, as well as how factors such as sugar intake or menopause-associated hormone changes can alter responses to sugar across a lifetime. In addition, Rick lays out strategies for combating the development of metabolic illness using dietary changes and pharmaceutical therapies, and he discusses the impact of fructose metabolism and uric acid on kidney function and blood pressure. He concludes with a discussion of vasopressin, a hormone that facilitates fructose’s effects on weight gain and insulin resistance.

We discuss:

Unique features of fructose metabolism and why it matters [2:45];
A primer on fructose metabolism and uric acid [10:30];
Endogenous fructose production, the polyol pathway, and the effect of non-fructose sugars [22:00];
Findings from animal studies of glucose and fructose consumption [29:00];
What calorie-controlled studies say about the claim that a “calorie is a calorie” [42:15];
Implications for aging and disease [51:15];
Impact of endogenous fructose production on obesity and metabolic syndrome [1:01:30];
Why vulnerability to the negative effects of sugar increases with age and menopause [1:04:30];
Dietary strategies to reduce the negative impact of fructose [1:16:30];
The role of hypertension in chronic disease and tips for lowering blood pressure [1:30:45];
The impact of fructose and uric acid on kidney function and blood pressure [1:39:45];
The potential role of sodium in hypertension, obesity, and metabolic syndrome [1:49:00];
The role of vasopressin in metabolic disease [1:54:00];
More.

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#193 - AMA #31: Heart rate variability (HRV), alcohol, sleep, and more Jan 31, 2022

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Episode Description:

In this “Ask Me Anything” (AMA) episode, Peter and Bob first answer a variety of questions related to heart rate variability (HRV): what it means, why it matters, and how to measure, interpret, and potentially elevate it. Next, they dive deep into the topic of alcohol, beginning with a discussion on the negative impact that it can have on sleep. They then break down the confusing body of literature suggesting potential health benefits to moderate levels of drinking compared to complete abstinence and point out the limitations of these studies. Finally, they conclude by analyzing data on the impact of moderate and heavy drinking on the liver and on risk for Alzheimer’s disease and dementia.

Please note: this AMA is audio only. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #31 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

What is heart rate variability (HRV), and why do we measure it? [2:10];
The association between low HRV and mortality risk [10:00];
What high and low HRV means and why athletes strive for a high HRV [15:30];
Factors that can raise or lower HRV [18:00];
How and when to measure HRV, and the best wearables [19:15];
Interpreting your personal HRV number and why there’s so much individual variation [23:15];
How Peter’s morning HRV reading impacts his decision to train [28:30];
Alcohol’s impact on sleep [31:30];
Metrics to track the impact of alcohol on your sleep [34:00];
Alcohol’s impact on the need to urinate during the night [39:00];
Alcoholic fatty liver disease (AFLD) [41:30];
Individual differences in the way people metabolize and react to alcohol consumption [44:15];
Analysis of epidemiology studies suggesting moderate alcohol consumption lowers mortality risk [52:00];
Alcohol consumption and Alzheimer’s disease [1:05:15];
Heavy alcohol consumption and risk of dementia [1:08:30];
Chronic effects of alcohol on the liver [1:17:45];
The relationship between alcohol, sleep, and automotive deaths [1:20:45]; and
More.

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#192 - COVID Part 2: Masks, long COVID, boosters, mandates, treatments, and more Jan 24, 2022

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Episode Description:

This episode is a follow-up to our recent COVID-19 podcast with Drs. Marty Makary and Zubin Damania (aka ZDoggMD). Here, we address many of the listener questions we received about our original discussion. In addition to Marty and ZDoggMD, we are also joined by Dr. Monica Gandhi, an infectious disease specialist and Professor of Medicine at the University of California, San Francisco. In this episode, we talk about new data on Omicron, long COVID, masks, kids and schools, vaccine mandates, policy questions, and treatments. We also discuss some of the most prevalent misinformation and spend time talking about claims made by Robert Malone. We end with a conversation about our exit strategy.

Please note: we recorded this episode on January 17, 2022, and in an effort to get it out as soon as possible, this won’t have full show notes or a video. Additionally, Monica was only able to join us for the first section of the podcast, so you’ll hear her drop off partway through.

We discuss:

Severity of infection from Omicron—reviewing the data [5:15];
Factors contributing to the relative mildness of Omicron infections [8:30];
Is SARS-CoV-2 evolving to cause less severe disease? [13:00];
Potential of Covaxin—an inactivated virus-based COVID-19 vaccine [17:45];
How B cells and T cells work together to defend against viruses [22:00];
Comparing COVID-19 vaccines, and the rationale for the time between doses [25:30];
Reviewing the purpose and effectiveness of boosters for reducing severity and transmission [32:30];
Debating vaccine mandates, and putting COVID’s mortality risk in perspective [41:00];
Why the topic of COVID has become so polarized [1:03:15]
Reviewing the data on masks for protecting oneself and protecting others [1:06:30];
The inconsistent logic used for mask mandates [1:16:00];
Long COVID and the potential for vaccines to reduce risk [1:21:45];
Risks for children and policies for schools [1:27:30];
Reviewing the outcomes from Sweden, where the government didn't impose lockdowns [1:31:00];
Draconian measures implemented in Canada [1:38:15];
Antiviral treatments for COVID and a common-sense approach [1:42:15];
Importance of ending tribalism and having rational discussions with humility [1:47:30];
Treating infection with monoclonal antibodies and convalescent sera [2:01:45];
Reviewing claims made by the controversial Dr. Robert Malone [2:11:15];
A potential exit strategy from the current situation [2:30:30];
Changes needed at the NIH [2:40:00];
More.

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#191 - Revolutionizing our understanding of mental illness with optogenetics | Karl Deisseroth M.D., Ph.D. Jan 17, 2022

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Episode Description:

Karl Deisseroth is a world-renowned clinical psychiatrist, neuroscientist, and author of Projections: A Story of Human Emotions. In the episode, Karl explains his unique career path that led to the development of optogenetics—a revolutionary technique that uses specialized light-sensitive ion channels to precisely control the activity of select populations of neurons. Karl provides a concise overview of how optogenetics works and how it can be used to better understand mental illness, to identify the neurons responsible for specific behaviors, and to guide development of new treatments. Karl uses his experience as a practicing psychiatrist to provide deep insights into depression, anxiety, autism, and personality disorders and explains the role of optogenetics in mapping out brain regions responsible for common mental health afflictions.

We discuss:

Karl’s journey through medical school and interest in the brain [5:00];
A profound medical school experience that changed Karl’s career path to psychiatry [17:30];
Karl’s commitment to research and challenges overcome early in his career [27:00];
The state of psychiatry and mental health therapies when Karl started his lab in 2004 [33:15];
Neuroscience 101: fundamentals of neuroanatomy and neurophysiology [38:15];
Traditional techniques for identifying the brain regions involved in specific behaviors [47:15];
Intro to optogenetics and how to get a gene into a neuron [51:15];
How viruses helped make optogenetics possible [1:01:45];
How optogenetics was used to investigate the effects of dopamine neurons [1:15:45];
Appreciating the power of optogenetics [1:22:00];
Investigating and treating anxiety with optogenetics [1:26:45];
Autism and autism-related anxiety, and the potential of optogenetics in treating autism [1:38:00];
Optogenetics as a powerful tool for the discovery and creation of medical treatments [1:45:00];
Karl’s inspiration to write his book, Projections [1:48:00];
Mania and bipolar disorder: evolutionary basis, symptoms, and the high prevalence in North America [1:52:45];
Depression: evolutionary basis and insights from optogenetics [2:03:15];
The effects of trauma early in life [2:18:45]; and
More.

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#190 - Paul Conti, M.D.: How to heal from trauma and break the cycle of shame Jan 10, 2022

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Episode Description:

Paul Conti, a returning guest on The Drive, is a practicing psychiatrist and recent author of Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal From It, in which he offers valuable insights on healing from trauma. In this episode, Paul explains how his personal experience with trauma and his many years seeing patients have shaped his understanding of trauma’s impact on the brain, its common patterns and manifestations, and how often people don't recognize the implications of trauma in their own life. He discusses major challenges in recognizing trauma, including the lack of biomarkers in psychiatry and psychology, as well as the misguidance of the mental health system in targeting symptoms as opposed to root problems. He talks about shame as the biggest impediment to healing from trauma and offers solutions to how, as a society, we can start to change the stigma of mental health and allow more people to receive help. Finally, he concludes with a discussion about the potential role of psychedelics like psilocybin and MDMA in treating trauma.

We discuss:

Paul’s background and unique path to psychiatry [2:30];
A personal tragedy that shaped Paul’s understanding of trauma and resulting feelings of shame and guilt [5:30];
The current state of psychiatry training and need for improvement [20:15];
The over-reliance on outdated metrics and lack of attention to past trauma as impediments to patient care [28:30];
Defining trauma: various types, heterogeneity, and effects on the brain [34:30];
Importance of finding the roots of trauma and understanding the “why” [47:00];
The major challenge of recognizing trauma in patients [55:15];
How shame and guilt are barriers to treatment and healing [1:06:00];
How treating trauma compares to treating an abscess—a powerful analogy [1:11:30];
How evolutionary survival instincts create problems in modern society [1:15:15];
First step toward healing: overcoming the fear of talking about past trauma [1:19:00];
Shame: the biggest impediment to healing [1:25:15];
The antidote to shame and the need for discourse and understanding [1:34:15];
The emotional health component of healthspan [1:41:15];
How to reframe the conversation about mental health for a better future [1:52:00];
The growing impact of trauma on our society and the need for compassion [1:58:45];
Society’s antiquated way of treating manifestations of trauma rather than root issues [2:04:15];
Potential role of psychedelics like psilocybin and MDMA in treating trauma [2:11:15];
Parting thoughts and resources for getting help [2:16:30];
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#189 - COVID-19: Current state of affairs, Omicron, and a search for the end game Jan 03, 2022

In this episode, Peter sits down with Drs. Marty Makary and Zubin Damania (aka ZDoggMD), both previous guests on The Drive. Marty is a Johns Hopkins professor and public health researcher and ZDoggMD is a UCSF/Stanford trained internist and the founder of Turntable Health. This episode, recorded on December 27, 2021, was in part inspired by some of the shoddy science and even worse messaging coming from top officials regarding COVID-19. In this discussion, Marty and ZDoggMD discuss what is known about the omicron variant, the risks and benefits of vaccines for all age groups, and the taboo subject of natural immunity and the protection it offers against infection and severe disease. Furthermore, they discuss at length the poor messaging coming from our public officials, the justification (and lack thereof) for certain mandates and policies in light of the current evidence, and the problems caused by the highly politicized and polarized nature of the subject. Themes throughout the conversation include the difference between science and advocacy, the messaging which is sowing mistrust in science despite major progress, and a search for what a possible “end” to this situation might look like.

NOTE: Since this episode was recorded over the holiday and published ASAP, this is an audio-only episode with limited show notes.

We discuss:

Comparing omicron to delta and other variants [4:15];
Measuring immunity and protection from severe disease—circulating antibodies, B cells, and T cells [13:15];
Policy questions: what is the end game and how does the world go back to 2019? [18:45];
A policy-minded framework for viewing COVID and the problem of groupthink [24:00];
The difference between science and advocacy [39:00];
Natural immunity from COVID after infection [46:00];
The unfortunate erosion of trust in science despite impressive progress [57:15];
Do the current mandates and policies make sense in light of existing data? [1:02:30];
Risks associated with vaccines, and the risk of being labeled an anti-vaxxer when questioning them [1:18:15];
Data on incidence of myocarditis after vaccination with the Pfizer and Moderna vaccines [1:26:15];
Outstanding questions about myocarditis as a side effect of mRNA vaccination and the benefit of boosters [1:35:00];
The risk-reward of boosters and recommendations being ignored by policy makers in the US [1:40:30];
Sowing distrust: lack of honesty and humility from top officials and policy makers [1:43:30];
Thoughts on testing: does it make sense to push widespread testing for COVID? [1:52:15];
What is the endpoint to all of this? [1:58:45];
Downstream consequences of lockdowns and draconian policy measures [2:05:30];
The polarized nature of COVID—tribalism, skeptics, and demonization of ideas [2:10:30];
Looking back at past pandemics for perspective and the potential for another pandemic in the future [2:20:00];
What parents can do if their kids are subject to unreasonable policies [2:25:00];
Voices of reason in this space [2:28:45];
Strong convictions, loosely held: the value in questioning your own beliefs [2:32:15];
More.

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Iñigo San Millán, Ph.D.: Zone 2 Training and Metabolic Health (Ep. #85 Rebroadcast) Dec 27, 2021

Today’s episode of The Drive is a rebroadcast of the conversation with Iñigo San Millán, (released on December 23rd, 2019). This episode with Iñigo was one of the most popular discussions to date and is a prelude to an upcoming follow-up discussion in 2022. In this episode, Dr. Iñigo San Millán, Assistant Professor at the University of Colorado School of Medicine, explains the crucial role of mitochondrial function in everything from metabolic health to elite exercise performance. Iñigo provides a masterclass into the many different energy system pathways, the various fuel sources (including the misunderstood lactate), the six zones of exercise training, and the parameters he uses to measure metabolic health. Additionally, he highlights the power of zone 2 training as both an effective diagnostic tool and, perhaps more importantly, as a treatment for mitochondrial and metabolic dysfunction. We discuss:

Iñigo’s background in sports and decision to focus on education [3:45];
The various energy systems and fuels used during exercise [11:15];
Iñigo’s qualification of energy systems into six training zones [19:30];
Lactate as an important fuel source [29:30];
Zone 2 training—physiologic characteristics, fuel sources, lactate, and the transition into zone 3 [37:00];
Using blood lactate levels (and zone-2 threshold) to assess mitochondrial function [43:30];
Accessing mitochondrial function by testing one’s ability to utilize fat as fuel [51:30];
Athletes vs. metabolically ill patients—mitochondria, fat oxidation, muscle glycogen capacity, “fat droplets”, and more [56:30];
Physiologic characteristics of zone 3, zone 4, and the lactate threshold [1:16:30];
Fueling exercise—dietary implications on glycolytic function [1:27:00];
Relationship between exercise and insulin sensitivity (and what we can learn from studying patients with type 1 diabetes) [1:43:00];
Metformin’s impact on mitochondrial function, lactate production, and how this affects the benefits of exercise [2:00:45];
Raising awareness of the risk of “double diabetes” [2:11:30];
How to dose zone 2 training, and balancing exercise with nutrition [2:14:30];
Proposed explanation of the Warburg Effect: Role of lactate in carcinogenesis [2:23:30];
Doping in cycling, and the trend towards altitude training [2:35:45] and;
More.

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#188 - AMA #30: How to Read and Understand Scientific Studies Dec 20, 2021

In this “Ask Me Anything” (AMA) episode, Peter and Bob dive deep into all things related to studying studies to help one sift through all the noise to find the signal. They define the various types of studies, how a study progresses from idea to execution, and how to identify study strengths and limitations. They explain how clinical trials work, as well as the potential for bias and common pitfalls to watch out for. They dig into key factors that contribute to the rigor (or lack thereof) of an experiment, and they discuss how to measure effect size, differentiate relative risk from absolute risk, and what it really means when a study is statistically significant. Finally, Peter lays out his personal process when reading through scientific papers.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #30 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

The ever changing landscape of scientific literature [2:15];
The process for a study to progress from idea to design to execution [4:15];
The various types of studies and how they differ [7:30];
The different phases of a clinical trial [19:15];
Observational studies and the potential for bias [26:30];
Experimental studies: Randomization, blinding, and other factors that make or break a study [44:00];
Power, p-values, and statistical significance [56:15];
Measuring effect size: Relative risk vs. absolute risk, hazard ratios, and “Number Needed to Treat” [1:07:45];
How to interpret confidence intervals [1:17:30];
Why a study might be stopped before its completion [1:23:45];
Why only a fraction of studies are ever published and how to combat publication bias [1:31:30];
Why certain journals are more respected than others [1:40:30];
Peter’s process when reading a scientific paper [1:43:45]; and
More.

#187 - Sam Apple: The Warburg Effect—Otto Warburg’s cancer metabolism theory Dec 13, 2021

Sam Apple is the author of the book Ravenous: Otto Warburg, the Nazis, and the Search for the Cancer-Diet Connection, published in May 2021. In this episode, Sam describes the fascinating life story of Otto Warburg, a Nobel Prize-winning scientist who, despite being both Jewish and gay, survived Nazi Germany because of his valuable research on cellular metabolism and cancer. Sam describes Warburg’s observation that cancer cells consume large amounts of glucose anaerobically – a phenomenon subsequently known as the “Warburg Effect” – and relates how Warburg’s seminal work on this topic was largely forgotten after the discovery of oncogenes, only to regain relevance decades later within the field of cancer biology. Sam sheds light on the current debate around Warburg’s interpretation of the causes of cancer, and Peter gives his personal take on the matter. Finally, Peter and Sam tie it all together with a discussion about cancer prevention, the role of hyperinsulinemia, and the link between dietary sugar and cancer. We discuss:

Sam’s interest in Otto Warburg and work as a writer [2:30];
Otto Warburg’s dedication to science and his complicated life in Germany [14:00];
Warburg’s interest in cancer and early discoveries about cellular consumption of oxygen [23:00];
The role models who fueled Warburg’s desire to make a great discovery [34:15];
How Warburg described the primary and secondary causes of cancer [42:15];
Warburg’s Nobel Prize in 1931 [45:45];
Warburg’s life and work during WWII in Nazi Germany [46:30];
Warburg’s research in hydrogen transfers and coenzymes—his best science? [59:45];
Warburg’s decision to stay in Germany after WWII [1:03:30];
Discovery of oncogenes in the 1970s and the decline in interest in Warburg’s ideas [1:07:30];
The renaissance of Warburg’s ideas on cancer metabolism and a new explanation for the Warburg Effect [1:13:45];
The argument against the Warburg Effect as a primary cause of cancer and the potential role hyperinsulinemia [1:21:15];
Identifying primary and secondary causes of cancer for the purpose of prevention [1:27:00];
The link between sugar, fructose, and cancer [1:35:30];
Sam’s reflections on the work that went into Ravenous [1:39:45];
More

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#186 - Patrick Radden Keefe: The opioid crisis—origin, guilty parties, and the difficult path forward Dec 06, 2021

Patrick Radden Keefe is an award-winning staff writer at The New Yorker and the bestselling author of Empire of Pain: The Secret History of the Sackler Dynasty. In this episode, Patrick tells the story of the Sackler family and Purdue Pharma - makers of the pain management drug OxyContin, providing the backdrop for the ensuing opioid epidemic and public health crisis. He reveals the implicit and sometimes explicit corruption of all parties involved in the development, approval, and marketing of OxyContin, leading to a cascade of unintended consequences including addiction and death. He explains the unfortunate lack of accountability for the current crisis, as well as what it all means for those with legitimate pain management needs. Finally, he examines the difficult path ahead towards finding a solution. We discuss:

Patrick’s investigation into distribution and use of drugs in our society [3:55];
The scale of the opioid crisis [9:15];
The Sackler brothers: family life, career in the pharmaceutical industry, and role in the current crisis [11:45];
Purdue Pharma: origins, early years, and move towards pain management drugs [17:30];
The development of OxyContin: its conception, marketing, and the controversy around the FDA approval process [25:30];
Early reports of OxyContin addiction and unintended consequences and how Purdue Pharma sidestepped responsibility [40:45];
The many paths to addiction and abuse of OxyContin and the ensuing downfall of Purdue Pharma [47:15];
Peter’s personal experience with OxyContin [57:00];
Pain—the “fifth vital sign,” how doctors are trained in pain management, and the influence of money [1:08:00];
Other players that helped facilitate the eventual opioid crisis [1:16:15];
Lack of accountability following the investigation and prosecution of Purdue and the Sackler family [1:23:30];
Legacy of the Sackler family and their disconnect from reality [1:34:45];
Patrick’s views on the regulation and use of pain management drugs [1:42:15];
The difficult path forward [1:44:45]; and
More.

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#185 - Allan Sniderman, M.D.: Cardiovascular disease and why we should change the way we assess risk Nov 29, 2021

Allan Sniderman is a highly acclaimed Professor of Cardiology and Medicine at McGill University and a foremost expert in cardiovascular disease (CVD). In this episode, Allan explains the many risk factors used to predict atherosclerosis, including triglycerides, cholesterol, and lipoproteins, and he makes the case for apoB as a superior metric that is currently being underutilized. Allan expresses his frustration with the current scientific climate and its emphasis on consensus and unanimity over encouraging multiple viewpoints, thus holding back the advancement of metrics like apoB for assessing CVD risk, treatment, and prevention strategies. Finally, Allan illuminates his research that led to his 30-year causal model of risk and explains the potentially life-saving advantages of early intervention for the prevention of future disease. We discuss:

Problems with the current 10-year risk assessment of cardiovascular disease (CVD) and the implications for prevention [4:30];
A primer on cholesterol, apoB, and plasma lipoproteins [16:30];
Pathophysiology of CVD and the impact of particle cholesterol concentration vs. number of particles [23:45];
Limitations of standard blood panels [29:00];
Remnant type III hyperlipoproteinemia—high cholesterol, low Apo B, high triglyceride [32:15];
Using apoB to estimate risk of CVD [37:30];
How Mendelian randomization is bolstering the case for ApoB as the superior metric for risk prediction [40:45];
Hypertension and CVD risk [49:15];
Factors influencing the decision to begin preventative intervention for CVD [58:30];
Using the coronary artery calcium (CAC) score as a predictive tool [1:03:15];
The challenge of motivating individuals to take early interventions [1:12:30];
How medical advancement is hindered by the lack of critical thinking once a “consensus” is reached [1:15:15];
PSK9 inhibitors and familial hypercholesterolemia: two examples of complex topics with differing interpretations of the science [1:20:45];
Defining risk and uncertainty in the guidelines [1:26:00];
Making clinical decisions in the face of uncertainty [1:31:00];
How the emphasis on consensus and unanimity has become a crucial weakness for science and medicine [1:35:45];
Factors holding back the advancement of apoB for assessing CVD risk, treatment, and prevention strategies [1:41:45];
Advantages of a 30-year risk assessment and early intervention [1:50:30];
More.

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Rick Johnson, M.D.: Metabolic Effects of Fructose (Ep. #87 Rebroadcast) Nov 22, 2021

Today’s episode of The Drive is a rebroadcast of the conversation with Rick Johnson (originally released January 6th, 2020). This episode was one of the most popular discussions to-date and is a prelude to an upcoming follow-up discussion which will be coming out in February 2022 along with the release of Rick’s new book. In this episode, Rick Johnson, professor of nephrology at the University of Colorado, explains how his research into the causes of blood pressure resulted in a change of research direction to focus more on how fructose has such profound metabolic effects. Rick begins by talking about the relationship between salt and high blood pressure, then provides a masterclass into uric acid, and then expertly reveals the mechanisms and pathways by which sugar (specifically fructose) can profoundly impact metabolic health. From there, he explains how he applies this information to real life patients as well as touches on some of the most promising ideas around pharmacotherapy that are being developed in response to the epidemics of fatty liver, insulin resistance, diabetes, and obesity. Furthermore, Rick gives his take on artificial sweeteners compared to real sugar, discusses cancer’s affinity for fructose, and much more. We discuss:

The connection between blood pressure and fructose that shifted Rick’s professional focus [3:00];
The relationship between salt and blood pressure (and the role of sugar) [4:45];
Defining fructose, glucose, and sugar [18:30];
An ancient mutation in apes that explains why humans turn fructose into fat so easily [22:00];
The problems with elevated uric acid levels, and what it tells us about how sugar causes disease [30:30];
How sugar causes obesity—explaining the difference in glucose vs. fructose metabolism and the critical pathway induced by fructose [39:00];
Why drinking sugar is worse than eating it [49:00];
Unique ability of sugar to drive oxidative stress to the mitochondria, insulin resistance, and diabetes [53:00];
Why cancer loves fructose [59:20];
The many areas of the body that can use fructose [1:04:00];
Fructokinase inhibitors—a potential blockbuster? [1:06:15];
Treating high uric acid levels—Rick’s approach with patients [1:09:00];
Salt intake—what advice does Rick give his patients? [1:15:30];
How excess glucose (i.e., high carb diets) can cause problems even in the absence of fructose [1:20:00];
Artificial sweeteners vs. real sugar—which is better? [1:28:15];
Umami, MSG, alcohol, beer—do these have a role in metabolic illness? [1:32:45];
Fructose consumption—Is any amount acceptable? Is fruit okay? Where does Rick draw a hard line? [1:37:45]
How does Rick manage the sugar intake of his young kids? [1:42:00]; and
More.

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#184 - AMA #29: GLP-1 Agonists—The Future of Treating Obesity? Nov 15, 2021

In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss all things related to GLP-1 agonists—a class of drugs that are gaining popularity for the treatment of obesity. They cover the discovery of these peptides, their physiology, and what it is they do in their natural state. Next, Peter and Bob break down a recently published study which showed remarkable results for weight loss and other metabolic parameters using a once-weekly injection of the GLP-1 agonist drug semaglutide, also known as Ozempic, in overweight and obese patients. Finally, they compare results from the semaglutide study to results from various lifestyle interventions and give their take on the potential future of GLP-1 agonists. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #29 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss:

Remarkable results of a recent study in overweight adults [2:15];
Key background on insulin, glucagon and the incretin effect [4:00];
What is GLP-1 and how does it work? [16:30];
2021 semaglutide study: remarkable results, side effects, and open questions [30:00];
Semaglutide vs. lifestyle interventions: comparing results with semaglutide vs. lifestyle interventions alone [44:00];
Closing thoughts and open questions on the therapeutic potential of semaglutide [47:30]; and
More

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#183 - James Clear: Building & changing habits Nov 08, 2021

James Clear is the author of the New York Times bestseller Atomic Habits. His extensive research into human behavior has helped him identify key components of habit formation and develop the “Four Laws of Behavioral Change.” In this episode, James provides insights into how both good and bad habits are formed, including the influence of genetics, environment, social circles, and more. He points to changes one can make to cultivate more perseverance and discipline and describes the profound impact habits can have when tying them into one’s self-identity. Finally, James breaks down his “Four Laws of Behavioral Change” and how to use them to create new habits, undo bad habits, and make meaningful changes in one’s life. We discuss:

Why James became deeply interested in habits [1:45];
Viewing habits through an evolutionary lens [6:00];
The power of immediate feedback for behavior change, and why we tend to repeat bad habits [9:15];
The role of genetics and innate predispositions in determining one’s work ethic and success in a given discipline [14:30];
How finding one’s passion can cultivate perseverance and discipline [23:15];
Advantages of creating systems and not just setting goals [29:15];
The power of habits combined with self-identity to induce change [36:30];
How a big environmental change or life event can bring on radical behavioral change [50:30];
The influence of one’s social environment on their habits [54:15];
How and why habits are formed [1:00:30];
How to make or break a habit with the “Four Laws of Behavior Change” [1:09:30];
Practical tips for successful behavioral change—the best strategies when starting out [1:16:15];
Self-forgiveness and getting back on track immediately after slipping up [1:30:30];
Law #1: Make it obvious—strategies for identifying and creating cues to make and break habits [1:39:45];
Law #2: Make it attractive—ways to make a new behavior more attractive [1:47:45];
Law #3: Make it easy—the 2-minute rule [1:58:45];
Law #4: Make it satisfying—rewards and reinforcement [2:03:30];
Advice for helping others to make behavioral changes [2:06:00];
More.

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#182 - David Nutt: Psychedelics & Recreational Drugs Nov 01, 2021

David Nutt is a psychiatrist and a neuroscientist at Downing College, Cambridge. His research focuses on illicit drugs—their harm, classification, and potential for therapeutic use in psychiatry. In this episode, David discusses his framework for assessing the potential harm caused by common recreational drugs and explains how they are regulated, which is oftentimes misaligned with actual risk. He describes in detail the neurobiology, mechanisms of action, and addiction potential of alcohol, opiates, cocaine, and methamphetamine and contrasts those with psychedelics, which have been given a similar regulatory classification despite their relatively low risk of harm and their numerous potential therapeutic uses. Additionally, David explains the promise of psychedelics like ketamine, MDMA, and psilocybin for treating drug addiction and depression and discusses how political pressures have created roadblocks to future necessary research. We discuss:

David’s early interest in the brain and experience in psychiatry [2:45];
David’s brief work on government drug policy in the UK [10:15];
A scale for rating the relative harm of certain drugs [13:45];
The contrast in regulation between cannabis vs. alcohol and why research on potential benefits of cannabis is lacking [19:15];
The opiate crisis and rise of fentanyl: the cause and potential solution [25:00];
The science of addiction and the potential use of psychedelics for treating drug addiction [35:00];
Cocaine: mechanisms of action and risks [41:45];
Methamphetamine and crystal meth: mechanisms of action and neurotoxicity [48:15];
How psychedelics came to be classified as schedule I drugs despite their numerous therapeutic uses [52:45];
The history of MDMA and the bad science and political forces leading to its demonization [1:08:45];
History of ketamine, medical use of esketamine, and the waning effects of psychedelics with increasing usage [1:13:30];
Psilocybin for depression: David’s promising research and the roadblocks to more robust experiments [1:20:15];More.

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#181 - Robert Gatenby, M.D.: Viewing cancer through an evolutionary lens and why this offers a radically different approach to treatment Oct 25, 2021

Robert (Bob) Gatenby is a radiologist who specializes in exploring theoretical and experimental models of evolutionary dynamics in cancer and cancer drug resistance. He has developed an adaptive therapy approach for treating cancer which has shown promise in improving survival times with less cumulative drug use. In this episode, Bob explains what brought him into medicine, his search for organizing principles from which to understand cancer, and the mathematical modeling of other complex systems that led him to model the dynamics of tumor cell changes in cancer. He discusses his pilot clinical trial treating metastatic prostate cancer, in which he used an evolutionary game theory model to analyze patient-specific tumor dynamics and determine the on/off cycling of treatment. He describes how altering chemotherapy to maximize the fitness ratio between drug-sensitive and drug-resistant cancer cells can increase patient survival and explains how treatment of metastatic cancer may be improved using adaptive therapy and strategic sequencing of different chemotherapy drugs. We discuss:

Bob’s unlikely path to medicine and disappointment with his medical school experience [1:45];
Rethinking the approach to cancer: using first principles and applying mathematical models [12:15];
Relating predator-prey models to cancer [26:30];
Insights into cancer gathered from ecological models of pests and pesticides [32:15];
Bob’s pilot clinical trial: the advantages of adaptive therapy compared to standard prostate cancer treatment [41:45];
New avenues of cancer therapy: utilizing drug-sensitive cancer cells to control drug-resistant cancer cells [48:15];
The vulnerability of small populations of cancer cells and the problem with a “single strike” treatment approach [56:00];
Using a sequence of therapies to make cancer cells more susceptible to targeted treatment [1:05:00];
How immunotherapy fits into the cancer treatment toolkit [1:15:30];
Why cancer spreads, where it metastasizes, and the source-sync trade off [1:20:15];
Defining Eco- and Evo-indices and how they can be used to make better clinical decisions [1:29:45];
Advantages of early screening for cancer [1:40:15];
Bob’s goals for follow-ups after the success of his prostate cancer trial [1:42:15];
Treatment options for cancer patients who have “failed therapy” [1:51:15];
More.

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#180 - AMA #28: All things testosterone and testosterone replacement therapy Oct 18, 2021

In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss all things related to testosterone: what happens when testosterone levels are low, and the potential benefits and risks of testosterone replacement therapy (TRT). They explain the physiology of testosterone, how it works, and how its level changes over the course of a person's life. They have a detailed discussion about existing literature, which reveals vast potential structural, functional, and metabolic benefits of testosterone replacement therapy. They also take a very close look at potential risks of this therapy, with a focus on the controversial effects on cardiovascular disease and prostate cancer. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #28 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss:

A primer on the hormone testosterone and how it influences gene expression [3:30];
How the body naturally regulates testosterone levels [11:30];
The defining threshold for "low testosterone," how low T impacts men, and why free testosterone is the most important metric [16:15];
When it makes sense to treat low testosterone [26:00];
The structural and metabolic benefits of testosterone replacement therapy [29:15];
Body composition changes with TRT [45:30];
Changes in bone mineral density with TRT [48:15];
The metabolic impact of TRT: glucose, insulin, triglycerides, and more [52:30];
A study investigating testosterone replacement therapy for prevention or reversal of type 2 diabetes [59:30];
The impact of TRT on metabolic parameters and body composition—A study comparing results from continuous vs. interrupted treatment [1:07:15]
The controversy over TRT and cardiovascular disease [1:21:45];
Two flawed studies that shaped perceptions of risks associated with TRT [1:44:15];
The controversy over TRT and prostate cancer [1:56:45];
Other potential risks with testosterone replacement therapy [2:02:15]; and
More

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#179 - Jeremy Loenneke, Ph.D.: The science of blood flow restriction—benefits, uses, and what it teaches us about the relationship between muscle size and strength Oct 11, 2021

Jeremy Loenneke has a Ph.D. in exercise physiology, a Master’s in nutrition and exercise, and is currently the director of the Kevser Ermin Applied Physiology Laboratory at the University of Mississippi, where he focuses his research on skeletal muscle adaptations to exercise in combination with blood flow restriction (BFR). In this episode, Jeremy explains the science of BFR and the mechanisms by which BFR training can produce hypertrophy using low loads. Here, he reviews anatomy and terminology of muscle structure and discusses the evidence that increasing muscular strength may not be dependent on increasing muscle size. Additionally, Jeremy goes into depth on how one might take advantage of BFR training, including practical applications for athletes and average people, as well as the situations for which BFR training would be most advantageous. We discuss:

Jeremy’s interest in exercise and weightlifting and his scientific training [3:30];
The microstructure and physiology of muscle [8:00];
Definitions of fast-twitch and slow-twitch muscle fibers [12:45];
Comparison of strength vs. hypertrophy [21:30];
Blood flow restriction training and the origins of the Kaatsu system [28:30];
The details and metrics related to exercise under blood flow restriction [44:45];
Considerations when training with blood flow restriction: loading, pace, rest, and risks [53:00];
Blood flow restriction studies and the relationship between muscle size and muscle strength [1:04:15];
Evidence that increasing muscular strength is not dependent on increasing the size of the muscle [1:16:30];
Practical applications of blood flow restriction training for athletes and average people [1:27:30];
Situations in which blood flow restriction training is most advantageous [1:35:30];
The mechanisms by which blood flow restriction training can produce so much hypertrophy at such low loads [1:39:45];
Applications of “passive” blood flow restriction training [1:47:15];
What experiments would Jeremy do if he had unlimited resources? [1:51:45];
More.

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#178 - Lance Armstrong: The rise, fall, and growth of a cycling legend Oct 04, 2021

Lance Armstrong is a legendary figure in professional cycling having won seven consecutive Tour de France titles but also a controversial figure facing scrutiny for the use of performance enhancing drugs. In this episode, Lance takes us through his meteoric rise to one of the most famous athletes in the world and his equally accelerated fall from grace. Lance describes how he persevered through his brutal diagnosis of testicular cancer before rattling off a historic run of seven consecutive Tour de France titles all while facing tremendous scrutiny for his alleged use of performance enhancing drugs such as EPO and cortisone. Lance opens up about his decision to come clean about his use of performance enhancing drugs, the remorse for how he treated other people during that time in his life, and the personal growth that’s helped him emerge on the other end of that. Finally, Lance recounts some of favorite stories from his cycling career, reflects on his legacy, and explains how he stays fit at age 50. We discuss:

What everyone wants to know—yes and no questions [2:15];
Lance’s childhood and beginnings of a great athlete [4:15];
Lance’s realization that he had a knack for racing after his first pro race at age 15 [13:00];
The move to cycling full time and a desire to compete in the Olympics [16:30];
Metrics tracked early in Lance’s career and his time with Motorola team [20:00];
The grueling nature of the Tour de France and the beginnings of serious drug usage in cycling [27:00];
The impact of EPO on cycling performance [35:15];
Testicular cancer diagnosis—denial, torturous symptoms, and treatment [38:15]
Livestrong is born [50:45];
Return to cycling post-cancer and a crossroad in Lance’s career [53:45]
Lance’s rise to prominence in the late 90s and the growing use of EPO in the sport [1:00:00];
Racing in the early 2000’s, blood transfusions, and rivalry with Jan Ulrich [1:12:00];
Retirement in 2005 and a comeback in 2009 [1:22:45];
Lance’s decision to come clean and tell the truth [1:27:30];
Growth through downfall: learning from his mistakes and helping others after their own fall from grace [1:33:00];
Moving forward: Living his life, reflecting on his legacy, the state of Livestrong [1:42:30];
Turning back the clock: Advice Lance would give to his 15 year-old self [1:46:45];
Keeping fit at age 50 [1:51:00];
More.

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#177 - Steven Rosenberg, M.D., Ph.D.: The development of cancer immunotherapy and its promise for treating advanced cancers Sep 27, 2021

Steve Rosenberg is the Chief of Surgery at the National Cancer Institute, a position he has held continuously for the past 47 years. Steve is a pioneer in the field of immunotherapies for cancer and a recipient of nearly every major award in science. In this episode, Steve discusses his inspiration for devoting his career to cancer research and describes his keen observation of two cases of spontaneous cancer remission, driving him to learn how to harness the immune system to treat cancer. Steve’s personal story essentially serves as a roadmap for the field of immunotherapy, from the very non-specific therapies such as interleukin-2, the discovery of tumor-infiltrating lymphocytes, checkpoint inhibitors, CAR T-cells, and adoptive cell therapy. Perhaps most importantly, Steve expresses his optimism for what lies ahead, especially in the face of some of the more recent discoveries with respect to tumor antigenicity. Finally, Steve discusses the human side of cancer which helps him to never lose sight of why he chose to become a physician. We discuss:

Steve’s childhood and inspiration to become a physician and medical researcher [3:15];
Patients that influenced Steve’s thinking about cancer and altered the course of his career [13:15];
The discovery of antigen presentation, Steve’s first job, and why he knew he wanted to study cancer [19:30];
Cancer treatment in the early 1970’s and Steve’s intuition to utilize lymphocytes [26:45];
Cancer cells versus non-cancer cells, and why metastatic cancer is so deadly [31:45];
The problem with chemotherapy and promise of immunotherapy [38:30];
How the immune system works and why it seems to allow cancer to proliferate [43:15];
Steve discovers how to use interleukin-2 to mediate cancer regression [52:00];
The immunogenic nature of certain cancers and the role of mutations in cancer [1:03:45];
The improbable story of how CAR T cell therapy was developed [1:16:30];
The discovery of tumor infiltrating lymphocytes (TIL) and engineering of T cells to recognize specific antigens [1:28:00];
Steve’s experience treating President Ronald Reagan’s colon cancer [1:36:00];
Why Steve has turned down many tempting job offers to focus on his research at the National Cancer Institute [1:41:00];
The role of checkpoint inhibitors in cancer therapy and the promise of adoptive cell therapy [1:43:00];
Optimism for using immunotherapy to cure all cancers [1:48:00];
The human side of cancer and the important lessons Peter learned from working with Steve [1:52:15]; and
More

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#176 - AMA #27: The importance of muscle mass, strength, and cardiorespiratory fitness for longevity Sep 20, 2021

In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss the longevity benefits from greater cardiorespiratory fitness (CRF) and greater muscle mass and strength. Conversely, they dive deep into the literature showing a rapid increase in morbidity and mortality risk as fitness levels decline with age. They also try to tease out the relative contributions of CRF, muscle mass, and strength. Additionally, they discuss the impact of fasting on muscle mass, the potential tradeoffs to consider, and finish by discussing why it’s critical to maximize your fitness level. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #27 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss:

VO2 max and its association with cardiorespiratory fitness [2:45];
Changing mortality risk based on VO2 max and cardiorespiratory fitness [7:45];
The profound impact of improving cardiorespiratory fitness [15:15];
Muscle mass, function, and loss with aging: how it’s defined, measured, and the cutoff points for sarcopenia [25:00];
Increasing mortality risk associated with declining muscle mass and strength [40:00];
Muscle size vs. strength—which has the bigger impact on mortality risk? [58:00];
Evaluating the cumulative impact of cardiorespiratory fitness and muscular strength on mortality risk when put together [1:03:30];
Investigating the rising incidence in deaths from falls, and what role Alzheimer’s disease might play [1:09:00];
The impact of fasting on muscle mass and the potential tradeoffs to consider [1:14:30];
The critical importance of working to maintain muscle mass and strength as we age [1:20:30]; and
More.

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#175 - Matt Kaeberlein, Ph.D.: The biology of aging, rapamycin, and other interventions that target the aging process Sep 13, 2021

Matt Kaeberlein is globally recognized for his research on the biology of aging and is a previous guest on The Drive. In this episode, Matt defines aging, the relationship between aging, chronic inflammation, and the immune system, and talks extensively about the most exciting molecules for extending lifespan. He discusses the current state of the literature of testing rapamycin (and rapalogs) in animals and humans, including Matt’s Dog Aging Project, and provides insights into how we can improve future trials by conceptualizing risk, choosing better endpoints, and working with regulators to approve such trials. He also examines the connection between aging and periodontal disease, biomarkers of aging, and epigenetic clocks. Finally, they explore some of the biological pathways involved in aging, including mTOR and its complexes, sirtuins, NAD, and NAD precursors. We discuss:

The various definitions of aging [3:25];
The relationship between disease and the biology of aging [16:15];
Potential for lifespan extension when targeting diseases compared to targeting biological aging [22:45];
Rapamycin as a longevity agent and the challenges of targeting the biology of aging with molecules [32:45];
Human studies using rapalogs for enhanced immune function [39:30];
The role of inflammation in functional declines and diseases of aging [50:45];
Study showing rapalogs may improve the immune response to a vaccine [56:15];
Roadblocks to studying gero-protective molecules in humans [1:01:30];
Potential benefits of rapamycin for age-related diseases—periodontal, reproductive function, and more [1:12:15];
Debating the ideal length and frequency of rapamycin treatment for various indications like inflammation and longevity [1:21:30];
Biomarkers of aging and epigenetic clocks [1:29:15];
Prospects of a test that could calculate biological age [1:37:45];
The Dog Aging Project testing rapamycin in pet dogs [1:42:30];
The role of the mTOR complexes [1:58:30];
mTor inhibitor called Torin2, mitochondrial disease and other potential pathways [2:09:45];
Catalytic inhibitors, sirtuins, and NAD [2:19:15];
NAD precursors: help or hype? [2:28:15]; and
More.

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#174 - Lawrence Wright: The 20th anniversary of the 9/11 attacks: reflections on how they happened, and lessons learned and not learned Sep 06, 2021

Lawrence Wright is the author of The Looming Tower: Al-Qaeda and the Road to 9/11 which won the 2007 Pulitzer Prize for general nonfiction and was named one of Time's top 100 books of all time. In this episode, released just before the 20th anniversary of the September 11th attacks, Lawrence and Peter discuss the book and the lasting impact of that day. Lawrence reflects on his personal experiences on that day and how he was first drawn into reporting on the attacks. Lawrence then discusses in detail the history that led up to 9/11 which is really composed of two parallel stories. The first story is of the growing discontent in Muslim countries, the roots of Islamic radicalism, and how two extremists, Osama bin Laden and Ayman al-Zawahiri, joined forces to create the global terrorist organization Al-Qaeda. The second story is about how interpersonal and institutional conflicts between the FBI and CIA led to a massive failure in intelligence and resulted in multiple missed opportunities to predict and prevent the attacks on September 11th, 2001. Finally, they reflect on what we should have learned from 9/11 and the future of terrorism.

We discuss:

Lawrence and Peter recount their personal experiences on September 11th, 2001 [3:30];
How 9/11 changed the US into a security state and affected a generation [9:45];
Lawrence’s early coverage of 9/11 and how he knew it was going to be “the story of our lifetime” [14:45];
Egyptian politics and the foundation of radical Islam [22:45];
Anwar Sadat’s presidency, assassination, and the birth of the radical Islamic movement [33:00];
Aftermath of the Sadat assassination, and establishment of Al-Qaeda in Afghanistan [50:15];
Osama bin Laden: Upbringing, involvement in the Soviet–Afghan War, and rise to celebrity status in Saudi Arabia [56:00];
How the Western intervention in Saudi Arabia impacted Arab nationalist’s hatred of America [1:15:30];
Theorizing on the role of the religion in holding back Islamic states from making progress towards democracy [1:20:30];
Bin Laden’s time in Sudan [1:32:30];
The CIA vs. the FBI: setting the stage for the failure of US intelligence [1:37:00];
The mistake by US intelligence of not taking the bombings of the US embassies and the USS Cole seriously [1:46:00];
Al-Qaeda in America: Losing the planners of the 9/11 attacks from our clutches and incompetence at the FBI and CIA [1:56:00];
Problematic policies in Europe, and a direct message warning of the 9/11 attacks [2:14:45];
The role of political infighting and personality conflicts that helped enable the 9/11 attacks and the lack of accountability [2:22:45];
What came of the 9/11 commission, the role of the Saudi government, and the trials of Ali Soufan [2:36:00];
Lessons from 9/11 and the future of terrorism [2:46:30]; and
More.

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#173 - AMA #26: Continuous glucose monitors, zone 2 training, and a framework for interventions Aug 23, 2021

In this “Ask Me Anything” (AMA) episode, Peter and Bob answer numerous follow-up questions to recently discussed deep-dive topics such as the use of continuous glucose monitors and getting the most from zone 2 exercise. They also discuss the incredible feats of cyclists in the Tour de France through the lens of the amazing performance physiology required from these athletes. Additionally, Peter ties the conversation together by sharing his foundational framework when considering different interventions, even in the absence of data from a randomized controlled trial. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #26 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss:

Peter’s foundational framework when considering different interventions [1:30];
Applying Peter’s framework to the idea of using a CGM [8:00];
Why certain fruits have a bigger impact on glucose, and the limitations of a CGM can tell you [16:00];
Importance of paying attention to insulin, and the prospects of a continuous monitor for insulin levels [20:00];
How exercise impacts glucose and peak glucose numbers to stay under [24:15];
Impact of anxiety on stress on glucose, and why it’s important to calibrate your CGM [26:30];
The five main tools for managing blood glucose numbers [33:45];
Benefits of moving or exercising after a meal, and where ingested carbohydrates get can be stored [37:15];
How to make decisions about an action or intervention in the absence of data from a rigorous, randomized controlled trial [40:30];
The incredible athletic feats of Tour de France cyclists [48:30];
Different modalities for doing zone 2 exercise: running, rowing, cycling, and more [1:00:15];
Proxies for knowing your in zone 2 short of using a lactate monitor [1:07:30];
Monitoring lactate for zone 2 exercise [1:10:00]; and
More.

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#172 - Esther Perel: The effects of trauma, the role of narratives in shaping our worldview, and why we need to accept uncomfortable emotions Aug 16, 2021

Esther Perel is a psychotherapist and New York Times bestselling author who is an expert on modern relationships. In this episode, Esther describes how being a child of parents who narrowly survived the Holocaust shaped and influenced her perspectives and ultimately led to her to a career in therapy. She discusses how the generational differences in parenting, among other things, led to the rise of individualism with a focus on happiness and self-esteem to the detriment of our relationships and sense of community. Ultimately, the conversation focuses on the value of our relationships with others for one’s sense of wellbeing, ability to deal with past trauma, resilience, and even our lifespan. She uses real world case studies to emphasize the therapeutic value of creating healthy relationships with others and oneself, explaining how our relationships with others can be a mirror into our own maladaptive behaviors. Esther explains how our self-narratives, which are often shaped by past trauma, may negatively impact our relationships with others and our emotional health, and emphasizes the value in trying to change them when warranted.

We discuss:

Esther’s background, adventures in hitchhiking, and how she ended up in the US [2:30];
The lasting effects of the Holocaust on Esther’s parents [8:45];
Grappling with a dark past and feeling alive again after trauma [16:45];
How Esther came to understand her parents in a new light [23:15];
Why Esther chose therapy as her career [30:00];
Using the concept of sexuality to understand society, culture, and people [40:00];
The significance of sexual revolutions, and the similarities of medical advancements and advancements in psychotherapy [50:15];
The impact of the rise of individualism and the focus on happiness and self-esteem [56:00];
Generational differences in parenting and changing role of fathers [1:09:15];
How our narratives affect our sense of wellbeing and relationships with others, and the challenge of changing them [1:17:15];
Generational effects of past trauma, and how relationship to others can be a mirror into your maladaptive behavior [1:30:30];
The role of willpower in one’s ability change their behavior and improve their relationships [1:40:00];
How your relationships impact longevity and the importance of being capable of sitting in uncomfortable emotions [1:43:45];
Esther’s definition of resilience and the dangers of believing everything you think or feel [1:50:00];
Questions about the human condition that Esther wants to explore [1:57:30]; and
More.

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#171 - Steve Austad, Ph.D.: The landscape of longevity science: making sense of caloric restriction, biomarkers of aging, and possible geroprotective molecules Aug 09, 2021

Steve Austad is a distinguished professor of biology at the University of Alabama and director of one of the Nathan Shock Centers of Excellence in aging biology. Steve's current research seeks to understand the underlying causes of aging, specifically with a long-term goal of developing medical interventions that slow the age-related decay of human health. In this episode, Steve tells Peter about his unusual childhood and stints as a cab driver and lion tamer. He goes on to describe what led to his focus on studying aging and some of the major challenges and limitations of working with laboratory animals. Steve and Peter talk about the relationship between caloric restriction and lifespan, including some of the most important studies exploring this question. Additionally, they hypothesize what might explain the sex-related differences in longevity between men and women, explain the importance of finding longevity biomarkers, and discuss the most promising molecules as potential longevity agents. We discuss:

Steve’s background and unusual childhood [2:30];
Steve’s adventures driving a cab in New York City [9:00];
How Steve drove to LA and accidentally became a lion tamer [13:30];
How Steve’s early graduate school experiences led him to study longevity [23:00];
The challenges and limitations of working with lab mice [30:45];
The connection between caloric restriction and lifespan [43:00];
Mice vs. rats and rodent aging experiments [51:15];
The impact of dietary composition and the harm of sucrose: Comparing two caloric-restriction studies in monkeys [56:00];
Challenges of studying animals due to major differences in the lab animal vs. wild animals [1:10:00];
Human studies of calorie restriction [1:24:45];
Better dietary protocols for humans: Alternatives to long-term caloric restriction [1:33:45];
The protective effect of fasting [1:38:00];
Reflecting on the sex differences in human lifespan, and why women have more neurodegenerative diseases [1:45:45];
The importance of identifying longevity biomarkers and which ones show the potential to change the landscape of longevity research [2:03:30];
Molecules showing the most promise as longevity agents [2:14:00]; and
More.

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#170 - AMA #25: Navigating the complexities and nuances of cancer screening Jul 26, 2021

In this “Ask Me Anything” (AMA) episode, Peter and Bob dive deep into cancer screening, including why it’s important, what you need to know about a test, and Peter’s approach with patients. They specifically discuss various screening methods, explain important terms like sensitivity and specificity, and how layering and stacking different tests in tandem can improve predictive values. They conclude with a discussion on one of the more exciting screening tools, diffusion-weighted MRI, and how it’s changing the cancer screening landscape. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #25 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss:

The importance of cancer screening [1:15];
Cancer screening terms: sensitivity, specificity, false positives, and false negatives [8:25];
Cancer screening terms: positive and negative predictive value [17:00];
Improving predictive value by layering tests, and the predictive values of mammograms [25:45];
How smoking impacts the predictive value of cancer screening [30:45];
Liquid biopsies for ruling out cancer and the blind spots of common cancer screening tests [33:00];
The difference between cancer originating from inside versus outside the body [41:15];
How diffusion-weighted MRI is changing cancer screening [45:15];
Summary of Peter’s approach to cancer screening [53:45]; and
More.

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#169 - Katherine Eban: COVID-19 Lab Leak: Examining all sides of the debate and discussing barriers to a full investigation Jul 19, 2021

Katherine Eban is an award-winning investigative journalist who previously appeared on The Drive to discuss the widespread fraud in the generic drug industry. In this episode, she discusses the content of her recent Vanity Fair article, which examined the evidence for the theory that the COVID-19 pandemic resulted from a virus lab escape as opposed to a natural virus that came from an animal host. Katherine and Peter walk through the evidence for both theories as well as discuss the long and troubling history of dangerous lab leaks and safety concerns about the Wuhan Institute of Virology. They also talk about the controversy surrounding gain-of-function research and its funding by the US government. Finally, they conclude with a discussion on the likelihood of definitively establishing the origins of the virus given the Chinese government’s lack of cooperation and highlight the fact that the many barriers to performing a full investigation may be the most troubling aspect of the controversy. This episode was originally recorded on July 6, 2021.

We discuss:

An overview of the lab leak controversy [1:30];
The troubling history of lab leaks of dangerous pathogens [8:30];
The zoonotic transmission theory: did SARS2 come from a bat? [11:45];
The debate about gain-of-function (GoF) research [26:15];
Questions about US funding of GoF research in China [33:45];
The uncertain significance of the furin cleavage site [51:30];
Discerning what’s most important about both the zoonotic transmission and lab leak theories [1:01:15];
Barriers to a full investigation [1:19:15]; and
More.

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#168 - Hugh Jackman: Reflections on acting, identity, personal transformation, and the significance of being Wolverine Jul 12, 2021

Hugh Jackman is an award-winning actor and an overall fascinating and introspective individual. In this episode, Hugh reflects upon his acting career, including how he navigated many tough decisions that led to important professional turning points for him. Peter and Hugh have an intimate discussion related to handling professional criticism, self-identity, spirituality, raising kids, and the role that past trauma often plays in extremely driven individuals. Hugh gives the inside scoop on some of his most well-known character roles and explains how he finds the energy to consistently perform. Finally, they tie the conversation together with a discussion on the importance of physical and mental health and wellbeing. We discuss:

Hugh’s voracious curiosity and early years of his acting career [2:15];
Self-identity, overworking, and the importance of living well [9:15];
Handling criticism and letting go of the desire to please everyone [18:30];
Dismissing vitriol on social media, and the challenge of communicating science [28:15];
Going with your gut and the value in finding the right partner [31:30];
A hard decision that lead to a turning point in Hugh’s life [40:15];
How driven personalities often develop from a place of trauma, and how to avoid going from productive to destructive [47:00];
The effect of fame on Hugh’s family [58:45];
How Hugh finds the energy to consistently perform, and the spiritual connection he feels when acting [1:07:15];
Hugh’s experiences on the set of The Fountain and the meaning behind the film [1:26:30];
The potential of imagination, the idea of a higher power, and thoughts on science vs. religion [1:33:45];
The deep connection Hugh felt to Logan (his character in Wolverine) [1:41:45];
Reflections on physical aging, emotional wellbeing, and longevity [1:55:15]; and
More

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#167 - Gary Taubes: Bad science and challenging the conventional wisdom of obesity Jun 28, 2021

Gary Taubes is an investigative science and health journalist and a best-selling author. In this podcast, Gary explains how he developed a healthy skepticism for science as he was transitioning from being a physics major to beginning as a science journalist. He talks about how he was particularly drawn to sussing out “pathologic science,” telling the stories behind his books on the discovery of the W and Z bosons and cold fusion, emphasizing the need for researchers to perform a thorough background analysis. Gary then describes how his work came to focus on public health, nutrition, and obesity. He provides a great historic overview of obesity research and provides his explanation for why the conventional wisdom today is incorrect.We discuss:

Gary’s background in science and journalism, and developing a healthy skepticism for science [2:20];
Gary’s boxing experience, and the challenge of appreciating behavioral risk [8:40];
How Gary developed his writing skills, and what the best science writers do well [16:45];
Example of how science can go wrong, and the story behind Gary’s first book, Nobel Dreams [25:15];
Theoretical vs. experimental physicists: The important differentiation and the relationship between the two [36:00];
Pathological science: research tainted by unconscious bias or subjective effects [40:30];
Reflecting on the aftermath of writing Nobel Dreams and the legacy of Carlo Rubbia [49:45];
Scientific fraud: The story of the cold fusion experiments at Georgia Tech and the subject of Gary’s book, Bad Science [53:45];
Problems with epidemiology, history of the scientific method, and the conflict of public health science [1:09:00];
Gary’s first foray into the bad science of nutrition [1:26:45];
Research implicating insulin’s role in obesity, and the story behind what led to Gary’s book, Good Calories, Bad Calories [1:36:15]
The history of obesity research, dietary fat, and fat metabolism [1:46:00]
The evolving understanding of the role of fat metabolism in obesity and weight gain [1:55:15]
Mutant mice experiments giving way to competing theories about obesity [2:04:00]
How Gary thinks about the findings that do not support his alternative hypothesis about obesity [2:08:00]
Challenges with addressing the obesity and diabetes epidemics, palatability and convenience of food, and other hypotheses [2:14:45];
Challenging the energy balance hypothesis, and the difficulty of doing good nutrition studies [2:25:00]; and
More.

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#166 - Patricia Corby, D.D.S.: Importance of oral health, best hygiene practices, and the relationship between poor oral health and systemic disease Jun 21, 2021

Dr. Patricia Corby is Associate Professor of Oral Medicine and Associate Dean of Translational Research at Penn Dental Medicine. Her work focuses on the importance of providing dental services alongside critical public healthcare services, like cancer treatment. In this episode, Pat provides an overview of dental anatomy, the importance of oral hygiene to overall health, and the association of poor oral health and systemic diseases like cancer and diabetes. She addresses tooth decay, oral hygiene in children, the utility of dental products, and ideal oral care regimens for different populations. She also discusses issues specific to immunocompromised patients and those with chronic illnesses as well as her own research with cancer patients undergoing radiation treatment.

We discuss:

Anatomy of teeth and the purpose of the dental pulp—a highly vascularized and innervated region of the tooth [3:00];
Types of teeth and the different purpose they serve [14:15];
Anatomy of the oral cavity, bacteria in the mouth, and what a healthy mouth looks like [18:10];
Pat’s study demonstrating the importance of flossing [23:00];
Detrimental effects of sugar and the importance of fluoride and oral hygiene [31:45];
Oral health challenges for cancer patients and immunocompromised people [39:45];
Pat’s current research on cancer patients undergoing radiation treatment and the oral health risks associated with human papilloma virus (HPV) [50:00];
Periodontal disease: caries and root canals [57:30];
The relationship between poor oral health and systemic health diseases [1:11:00];
Potential connection between oral hygiene and COVID-19 [1:17:45];
Dry mouth leading to oral infections and ways to prevent it [1:22:30];
What determines the appearance of teeth, methods of teeth whitening, and whether you should remove mercury fillings [1:27:30];
Importance of fluoride for preventing tooth decay, and dental care for children [1:32:45];
Useful dental products: floss, electrics toothbrushes, and more [1:39:15];
Ideal oral care regimens [1:47:30]; and
More.

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#165 - AMA #24: Deep dive into blood glucose: why it matters, important metrics to track, and superior insights from a CGM Jun 14, 2021

In this “Ask Me Anything” (AMA) episode, Peter and Bob dive deep into blood glucose and why it matters so much with respect to metabolic health and longevity. They explain the need to pay close attention to metrics like average blood glucose, glucose variability, and peak glucose numbers. Additionally, Peter explains why he encourages all his patients, even nondiabetics, to utilize a continuous glucose monitor (CGM) which gives important insights that traditional lab testing and metrics consistently miss.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #24 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

The problem with traditional blood tests and metrics for determining metabolic health [1:10];
The superior insights from a continuous glucose monitor [6:15];
Why lower is better than higher: average glucose, glucose variability, and glucose peaks [12:00];
Deep dive into average blood glucose and the importance of having the lowest average blood glucose possible [14:45];
Deep dive into glucose variability and why less variability is better [33:15];
Example of how HbA1c and traditional measures could catch metabolic issues too late [41:45];
Postprandial dips in blood glucose as a predictor of subsequent hunger and energy intake [43:00];
Exploring the idea that the suppression of fatty acids is actually causing hunger rather than a low blood glucose [49:45];
Deep dive into peak glucose and why lower peaks is better [57:15];
What the best rodent models tell us about the impact of peak glucose levels [1:06:25];
Why Peter encourages all his patients to wear a CGM [1:14:30]; and
More.

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#164 - Amanda Smith, M.D.: Diagnosing, preventing, and treating Alzheimer’s disease, and what we can all learn from patients with dementia Jun 07, 2021

Amanda Grant Smith is a geriatric psychiatrist with decades of experience treating patients with dementia and Alzheimer's disease. In this episode, Amanda shares how she developed a passion for geriatric psychiatry as a means to support dementia patients. She explains how to recognize, define, and diagnose dementia—a process that still remains somewhat elusive. They also talk about the significance of ApoE genotype and compare the various forms of dementia including differentiating between Alzheimer’s disease and Lewy body dementia. They discuss the current landscape of clinical trials, the drug pipeline, and talk about a very promising monoclonal antibody directed at amyloid beta that has the potential to be a disease-modifying drug. They conclude with a discussion about how to define “healthy aging” and reflect on how understanding dementia can shape one’s life philosophy.

We discuss:

How Amanda developed a passion for geriatric psychiatry [3:15];
Defining and diagnosing dementia and Alzheimer’s disease [13:30];
Medical tests for dementia and their relationship to clinical symptoms [22:45];
The pathology of dementia, and the role of the tau and beta-amyloid protein in Alzheimer’s disease [33:15];
The significance of ApoE genotype, and differentiating Alzheimer’s disease from Lewy body dementia [43:15];
The evolution of Alzheimer’s disease prevention, care, and medications over the last 20 years [52:45];
Psychiatric support for dementia patients (and caregivers) with depression and anxiety [1:02:45];
Drug pipeline, clinical trials, and major challenges to overcome [1:13:45];
Redefining Alzheimer’s disease and designing effective trials [1:23:00];
The promise of monoclonal antibody treatments for Alzheimer’s disease [1:34:15];
How we should measure outcomes in dementia trials and define “healthy aging” [1:42:30];
How understanding dementia can reshape our life philosophy [1:53:45]; and
More.

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#163 - Layne Norton, Ph.D.: Building muscle, losing fat, and the importance of resistance training May 24, 2021

Layne Norton is a physique coach, a natural professional bodybuilder and powerlifter, and holds a Ph.D. in nutritional sciences. In this episode, Layne explains how he became interested in weightlifting and fitness both professional and academically. He provides insights into preventing and managing injuries while using consistency and determination to boost his professional success in bodybuilding and powerlifting. Peter and Layne also review the science of body composition and what’s really driving muscle growth, including the role of nutrition, supplements, and a number of important and misunderstood hormones important to muscle protein synthesis. Furthermore, Layne stresses the importance of maintaining muscle mass even while losing fat for improving metabolic health and longevity and provides the keys to developing healthy habits.

We discuss:

Layne’s childhood and why he gravitated towards weightlifting and bodybuilding [2:45];
Layne’s academic path, overcoming ADHD, and kicking Adderall [11:45];
Paradoxical observations about expertise, and Layne’s career transition to health and fitness [22:00];
The power of persistence and resilience in the face of setbacks [32:15];
Battling injuries, managing back pain, and setting lifting records [43:00];
Bodybuilding vs. powerlifting: comparing and contrasting the training approaches [57:15];
Cutting weight without losing muscle mass: exercise and dietary protocols, fasting, and a look at the literature [1:06:00];
Muscle protein synthesis and the importance of leucine [1:25:30];
Nitrogen balance and muscle protein synthesis, and the regulatory role of hormones for fat flux and muscle growth [1:37:00];
What’s really driving muscle growth: intrinsic vs. systemic factors, IGF, and hormone signaling [1:46:30];
The role of protein, carbohydrates and insulin on muscle growth and preservation, and the importance of context when interpreting study results [1:55:30];
Clarifying the role of cortisol—a misunderstood hormone [2:07:45];
The problem with studies trying to isolate one nutrient [2:15:00];
The important role of inflammation from exercise [2:19:25];
Keys to preserving muscle, and the value of habits, consistency, and resilience [2:23:30]; and
More.

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#162 - Sarah Hallberg, D.O., M.S.: Challenging the status quo of treating metabolic disease, and a personal journey through a grim cancer diagnosis May 17, 2021

Sarah Hallberg is the Medical Director at Virta Health and a physician who has spent nearly two decades treating patients with obesity and type 2 diabetes. In the first half of this episode, Sarah discusses how she became a huge believer in the efficacy of carbohydrate restriction for the treatment of type 2 diabetes through her research and clinical experience. Sarah challenges the common beliefs about the role of dietary fat and carbohydrate on the plasma makeup of fatty acids and triglycerides. She also expresses the importance of understanding early predictors of metabolic illness—highlighting one particular fatty acid as the most important early predictor—before finishing with a discussion about how doctors might be able to personalize patients’ metabolic management in the future. In the second half of this episode, Sarah tells the personal story of her own lung cancer diagnosis. She talks about dealing with her grief, deciding to continue her work while prioritizing her family, and how she devised a plan to extend her survival as long as possible.

We discuss:

How Sarah discovered the profound impact of carbohydrate restriction for reversing obesity and type 2 diabetes [3:15];
Prediabetes and metabolic syndrome: prevalence, early signs, and the importance of treating early [16:00];
Overview of fatty acids, how they are metabolized, and understanding what you see in a standard blood panel [29:15];
The relationship between diet composition and metabolic markers [35:15];
Why palmitoleic acid is such an important biomarker [48:15];
The best early indicators of metabolic disease [1:00:00];
Personalized management of metabolic illness [1:07:00];
Sarah’s cancer diagnosis and the beginning of her journey [1:15:15];
The emotional impact of a devastating diagnosis [1:27:15];
Sarah’s plan to extend survival [1:36:45];
Sarah’s aggressive treatment plan [1:47:30];
Life-threatening complications and the return of her cancer [1:59:00];
Sarah’s reflections on her approach to life with chronic cancer and balancing her time [2:11:00]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/SarahHallberg Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#161 - AMA #23: All Things Nicotine: deep dive into its cognitive and physical benefits, risks, and mechanisms of action May 10, 2021

In this “Ask Me Anything” (AMA) episode, Peter and Bob dive deep into nicotine, a complicated and interesting molecule that has effects on both the brain and the body. They analyze the results of the studies that describe nicotine’s cognitive benefits and potential for inducing weight loss. They talk about a smoking cessation technique called nicotine replacement therapy and give a full breakdown of the various routes of administration, dosing, and safety. Finally, they explore the fascinating and counterintuitive observation that cigarette smokers are less likely to get a severe case of COVID-19. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #23 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss:

How Peter first became interested in the potential benefits of nicotine [1:15];
Untangling nicotine from tobacco [6:00];
Nicotine replacement therapy (NRT) for quitting smoking: products, protocols, and a review of the literature [9:30];
The cognitive benefits of nicotine: Overview of the literature [15:50];
Where nicotine has the most positive impact on cognition [30:30];
Possible mechanisms conferring the benefits of nicotine [37:00];
How modafinil and other nootropics compare to nicotine [47:15];
How nicotine may induce weight loss [54:00];
Relationship between smoking and COVID-19: Analyzing the observation that smoking appears protective against COVID-19 [1:01:45];
Breakdown of the various nicotine replacement therapies: route of administration, dosing, and safety [1:11:30];
Concluding thoughts on nicotine: use cases, addictive properties, and more [1:19:45]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama23 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#160 - Paul Offit, M.D.: The latest on COVID-19 vaccines and their safety, herd immunity, and viral variants May 03, 2021

Paul Offit is a pediatrician specializing in infectious diseases and an expert in virology and vaccine development. He currently serves on the FDA committee evaluating COVID-19 vaccines. In this episode, Paul’s second appearance on The Drive, he provides an update on all the SARS-CoV-2 vaccines currently deployed, explains why the concerns raised around the mRNA vaccines are not legitimate, and offers his view on the prospects and timeframe of reaching herd immunity. He also takes a deep dive into immunology, explaining the short-term and long-term immune response to both natural infection and vaccination and how these two can function together to provide durable immunity. Additionally, they discuss the theories on the origins of this virus, what impact the new COVID-19 variants might have, and the recent pausing of the J&J vaccine. Finally, they discuss how we can be better prepared for an inevitable future outbreak of a novel virus. This episode was originally recorded on April 14, 2021.

We discuss:

Overview and current status of the SARS-CoV-2 vaccine strategies [4:10];
Addressing concerns about mRNA vaccines [9:00];
How the failure to make an effective HIV vaccine aided the development of a COVID-19 vaccine [16:45];
Where SARS-CoV-2 falls on the spectrum of its ability to mutate and what that means for immunity and vaccination [21:30];
How the combination of short-term and long-term immune response to SARS-CoV-2 work together to provide durable immunity [28:00];
Importance of understanding relative vs. absolute risk reduction [38:15];
Implications of pausing the J&J vaccine due to reports of blood clotting in the brain [42:45];
What constitutes herd immunity and the concerns of rising vaccine hesitancy [47:45];
When we might reach herd immunity, future vaccines for children, and long-term outlook for maintaining population immunity [58:45];
Theories about the origins of SARS-CoV-2 [1:07:00];
Preparing for the possibility of a future pandemic and how we can learn from our mistakes [1:10:40]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/pauloffit2 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#159 - Peter Hotez, M.D., Ph.D.: Evolution of the anti-vaccine movement, the causes of autism, and COVID-19 vaccine state of affairs Apr 26, 2021

Peter Hotez is an internationally recognized physician-scientist in neglected tropical diseases and vaccine development. In this episode, they first follow up on the podcast episode (#158) with Brian Deer (the investigative journalist who exposed the complex and disturbing story behind the infamous 1998 Lancet paper by Andrew Wakefield linking the MMR vaccine and autism) with a broader discussion about the origin and evolution of the anti-vaccine movement. They explore some of the specific claims being made around vaccine additives, the timing of when vaccines are given, and claims about issues with the HPV vaccine specifically. Next, Dr. Hotez shares his own journey as a parent of an autistic child and speaks of the challenges of diagnosing autism, what could account for the seeming increase in the prevalence, and whether there is any support for the notion that environmental triggers play a role. They close out with a discussion on the state of affairs with respect to COVID-19 vaccination, comparing the various vaccines as well as the challenges that emerging variants of the virus may present. This episode was originally recorded on April 2, 2021.

We discuss:

The stubborn persistence of anti-vaccine sentiment (3:00);
A closer look at claims about thimerosal and vaccine spacing causing autism (12:00);
The Hib vaccine: An example of the profound difference a vaccine can make (23:30);
The controversy surrounding the human papillomavirus (HPV) vaccine (30:45);
The growing anti-science sentiment, COVID vaccine hesitance, and the basis of the anti-vaxx movement (39:00);
The origins of autism, and Hotez’s personal story as a parent of an autistic child (1:02:45);
The challenge of diagnosing autism, increasing prevalence, and a potential parallel to Alzheimer’s disease (1:14:15);
Comparing the various COVID-19 vaccines and the impact of emerging variants of the virus (1:30:00);
Global vaccination challenges and “vaccine diplomacy” (1:40:45); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/PeterHotez3 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#158 - Brian Deer: A tale of scientific fraud—exposing Andrew Wakefield and the origin of the belief that vaccines cause autism Apr 19, 2021

Brian Deer is an award-winning investigative journalist best known for his coverage of the pharmaceutical industry. In this episode, he and Peter discuss the content of his book, The Doctor Who Fooled the World: Science, Deception, and the War on Vaccines, which exposes the complex and disturbing story behind the infamous 1998 Lancet paper by Andrew Wakefield linking the MMR vaccine and autism. Brian explains how doctors led by Wakefield, a lawyer, and an anti-vaccination parents’ group worked together on a study to validate their preconceived belief that the MMR vaccine caused autism. He reveals what happened behind the scenes as the study was carried out, explains problems in the lab, and discusses inconsistencies in the analysis. In the end, this is a story that serves as a cautionary tale about the consequences of science driven by an agenda rather than by a spirit of open inquiry.

We discuss:

How Andrew Wakefield’s flawed approach to scientific research led to the belief that vaccines cause autism (3:25);
The importance of following the scientific method, and how Wakefield twisted the science to link measles virus to Crohn’s disease (14:15);
The backstory behind Andrew Wakefield’s infamous 1998 Lancet paper linking the MMR vaccine and autism (26:45);
The many flaws and disturbing aspects of Wakefield’s study: suffering children and failure to do strain-specific sequencing (45:15);
The epicenter of fraud: Bogus PCR testing furthering the belief that measles virus from the MMR vaccine caused autism (1:00:00);
Additional issues that contaminated the study results (1:22:15);
Discovering the misrepresented medical records for the kids involved in the study leading to the retraction of the Lancet paper and Wakefield losing his license (1:31:00);
The resurgence of the anti-vaccination movement, Brian’s motivation to write the book, and parting thoughts (1:36:45); and
More.

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#157 - AMA #22: Losing fat and gaining fat: the lessons of fat flux Apr 12, 2021

In this “Ask Me Anything” (AMA) episode, Peter and Bob take a deep dive into fat flux. They define the major players that impact the flow of fat entering and exiting a fat cell, which determines how much fat a person carries. They discuss the significant influence that insulin has on the net fat balance and explore common strategies, such as fasting and low-carb diets, that have efficacy in the liberation and oxidation of fat from fat cells. Additionally, Bob explains his research process and how he seeks answers to Peter’s challenging questions.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #22 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

The two main ways to reduce fat mass (1:30);
Explaining fat flux—how fat enters and exits a fat cell (9:15);
What fat balance looks like (21:15);
What net fat influx looks like, and the impact of insulin in lipolysis (24:30);
What net fat efflux looks like, and the benefits of fasting to break the hyperinsulinemic cycle (28:30);
Exploring why most people with excess body fat will lose fat mass when reducing carbohydrates or eating a ketogenic diet (32:45);
Why being in nutritional ketosis does not automatically translate to negative fat flux (fat loss) (42:40);
Bob’s approach to scientific research (47:00);
The importance of curiosity and a desire to learn (58:30);
Bob’s tips and tricks for answering a scientific question in a time-crunch (1:00:00); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama22/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#156 - Jake Muise: Humanely harvesting axis deer while alleviating its impact on Hawaii’s vulnerable ecosystems Apr 05, 2021

Jake Muise is an avid hunter, environmentalist, and advocate for the preservation of Hawaii’s natural resources. He is the founder of Maui Nui Venison, a company which actively manages Hawaii’s imbalanced population of axis deer by harvesting them as a food resource. In this episode, Jake tells his unbelievable backstory growing up in Northern Alberta before landing in Hawaii on a volleyball scholarship where he fell in love with the islands and the people. Jake explains how axis deer—a non-native species—were brought to the islands and how they have since become imbalanced to the detriment of Hawaii’s precious ecosystems. He goes on to explain the incredible lengths that his company has taken to ensure the most humane harvesting techniques imaginable resulting in a food source that is as clean and healthful as can be. Additionally, Jake and Peter examine what makes meat from axis deer one of the most nutrient-dense red meats on the planet.

We discuss:

Upbringing in Northern Alberta, a diet of moose meat, and learning to surf in Nova Scotia (3:35);
How volleyball brought Jake to Hawaii where he met the Molokai people (14:00);
Jake’s introduction to axis deer (26:30);
Pro volleyball in Europe, missing the Olympic team by one spot, and his return to Hawaii (29:00);
History of axis deer in Hawaii—how a non-native species came to the islands, and the superpowers that make them so hard to hunt (34:00);
A potential catastrophe avoided on The Big Island—The amazing story of how Jake tracked and found axis deer that were secretly brought to The Big Island (52:15);
Jake’s work helping ranchers on Maui (1:08:15);
The detrimental impact of an imbalanced axis deer population (1:10:30);
The incredible evacuation of farm animals from lava-locked land due to a volcano eruption (1:17:00);
The creation of Maui Nui Venison—going above and beyond USDA requirements (1:27:00);
The most humane way to harvest an animal—the unmatched standards Maui Nui Venison uses to harvest axis deer (1:32:00);
Why meat from axis deer is nutritionally superior (and tastes better) than other meats (1:46:00);
Why axis deer meat is the best option for those reluctant to eat meat: True nose-to-tail nutrition and ethical harvesting (1:58:15);
What a truly balanced population of axis deer on Hawaii would look like (2:06:15);
Maui Nui Venison’s charitable work during the COVID crisis (2:12:45); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/jakemuise Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#155 - Chris Sonnenday, M.D.: The history, challenges, and gift of organ transplantation Mar 29, 2021

Chris Sonnenday is the Transplant Center Director for Michigan Medicine. As Peter’s senior resident while at Johns Hopkins, Chris made a lasting impression on him with his remarkable leadership and ability to maintain his humanity through the stressors of that challenging environment. In this episode, Chris tells the incredible backstory of the history of transplant medicine, focusing on the kidney and the liver. He discusses the surgical and immunologic developments that launched the field forward, but also lays out the challenges ahead for the field, such as the rising prevalence of chronic kidney and liver failure. Chris also tells many stories of tragedy and triumph that comes with working in organ transplantation, but ultimately explains the rewarding nature of being a witness to the gift of organ donation.

We discuss:

What attracted Chris to medicine, and his leadership in residency (3:30);
How Chris maintained his empathy and humanity through the stresses of med school and residency (8:30);
Why Chris chose a complicated field like transplant medicine (23:15);
Explaining kidney transplantation to showcase the challenge of organ transplantation surgery (28:00);
Overcoming the immune-based challenges of transplant surgery (37:00);
How the discovery of cyclosporine transformed the field of organ transplantation (49:00);
Rising chronic kidney failure due to the prevalence of pre-diabetes and metabolic syndrome (53:45);
Why living kidney donations are superior, and the possibility of a market for kidney donation (59:30);
Designing a fair system of organ distribution (1:17:30);
The debate on what constitutes “death” when deciding when to take organs from a registered organ donor (1:21:45);
Reflections on the gift of organ donation (1:33:15);
The history of liver transplantation and why it’s so complex (1:39:15);
Addressing acute liver failure and the amazing baboon experiment (1:46:15);
The potential for the rising prevalence of NAFLD and NASH to overwhelm the liver transplant infrastructure in the US (1:54:45);
The importance of teamwork in successful organ transplantations, and the most tragic event Chris has ever witnessed (2:05:45); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: http://peterattiamd.com/ChrisSonnenday Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#154 - Steve Levitt, Ph.D.: A rogue economist’s view on climate change, mental health, the ethics of experiments, and more Mar 22, 2021

Steven Levitt is a professor of economics at the University of Chicago and the co-author of the bestselling book Freakonomics and its two sequels. In this episode, Steve discusses his unlikely path to a career in economics and his view of the current state, and limitations, of the field. He also gives his unique perspective on contemporary issues including climate change, mental health in education, how to evaluate whether an experiment is ethical, decision making, horse racing, and much more.

We discuss:

How Steve ended up in economics (2:45);
Current trends in the field of economics: macro vs. micro, usefulness of models, and the relationship between data and theory (8:45);
Revisiting what Steve wrote about climate change in SuperFreakonomics, and why it’s unlikely to be solved with behavioral change (18:45);
The consequences of a blurred line between climate science and advocacy (27:30);
Answering climate questions with a “Manhattan Project for climate change” (31:45);
Steve’s reflections on his career path and how he found his way by being himself (40:00);
How Steve came to write Freakonomics (and its sequels), and the topics which caused the most controversy (53:00);
How Steve came to appreciate mental health through parenting, and the need to emphasize mental health into the education system (1:10:15);
Why people are bad at making decisions (1:26:45);
Deliberating on why horse racing times haven’t advance much in decades (1:34:30);
Reducing the impact of negative emotions by observing the world free of language (1:44:00);
Changing our thinking about what it means to conduct experiments ethically (1:49:00); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/SteveLevitt Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#153 - AMA #21: Deep dive into olive oil, high-intensity exercise, book update, and more Mar 15, 2021

In this “Ask Me Anything” (AMA) episode, Peter and Bob take a deep dive into olive oil. They explore the history of olive oil, discuss observational data that led to the hypothesis that olive oil is a healthier alternative to many other fats, and they explain the classification of olive oil types —including what to look for in a high-quality “extra virgin” olive oil. Peter and Bob round out the discussion with a “two-minute drill,” in which Peter answers questions from subscribers. They cover zone 5 training, an update on Peter’s book, lactate meters, standing desks, massage guns, electrolyte supplementation, and more.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #21 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

The early history of olive oil and the Mediterranean diet (2:15);
The three broad categories of fats: SFA, MUFA, and PUFA (6:25);
Exploring the hypothesis that olive oil is healthy (10:30);
Comparing olive oil to the makeup of other common oils (30:00);
Defining “extra virgin” olive oil, what to look for when purchasing, and Peter’s favorite brand (34:30);
Update on Peter’s book (47:15);
Zone 5 training: Peter's approach to zone 5 training, and other anaerobic training protocols (49:30);
Advantages of using a standing desk compared to sitting (55:30);
Lactate meters and strips (57:45);
Electrolyte supplementation during fasting and ketosis, and why uric acid may increase (59:30);
The usefulness of massage guns, foam rollers, and professional massage for muscle pain and tightness (1:01:30); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama21/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#152 - Michael Rintala, D.C.: Principles of Dynamic Neuromuscular Stabilization (DNS) Mar 08, 2021

Michael Rintala is a sports medicine chiropractor and one of only 18 international instructors teaching dynamic neuromuscular stabilization (DNS) for the Prague School of Rehabilitation. This episode focuses on understanding DNS, including the foundational principles and how it relates to human motor development. Michael also shares the most common injuries and issues he sees in patients in his practice, such as postural problems and back pain, and how the movements of a DNS program are used to avoid injury, maintain longevity, and improve sports performance.

We discuss:

Michael’s background in chiropractic sports medicine and rehabilitation (3:15);
The Prague School of Rehabilitation, and functional rehabilitation as the foundation of the dynamic neuromuscular stabilization (DNS) program (5:00);
Foundational principles of DNS, and the role of the diaphragm in muscular stability (19:00);
Types of muscle contractions (28:15);
Human motor development through the lens of DNS, and when issues begin to arise (32:30);
Common postural syndromes (50:00);
Increasing functional threshold to minimize time in the functional gap (56:45);
DNS for injuries, pain, pre-habilitation, and performance enhancement (1:03:45);
Etiology of back pain (1:10:00);
How a stress fracture in his back led Michael to the Prague School (1:16:00);
The Prague School curriculum: 3 tracks for certification in DNS (1:20:45); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/MichaelRintala/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#151 - Alex Hutchinson, Ph.D.: Translating the science of endurance and extreme human performance Mar 01, 2021

Alex Hutchinson is a sports science journalist, author of the book Endure—which explores the science of endurance and the real limits of human performance—and former competitive runner for the Canadian national team. In this episode, Alex tells the story of his “aha moment” during a meaningless track meet that catapulted his running career and seeded his interest in the power of the mind. He then explains the science behind VO2 max, the difference between maximum aerobic capacity and efficiency, and extracts insights from examples of extreme human performance, such as the recent attempts to break the 2-hour mark in the marathon. Finally, he brings it back to what this all means for the everyday person: optimal exercise volume for maintaining health, how to avoid acute and chronic injuries, how to diversify your exercise portfolio, HIIT protocols, and much more.

We discuss:

Alex’s background and passion for running (3:00);
The power of the mind: Alex’s “aha moment” that catapulted his running career (9:00);
Pursuing a Ph.D. in physics while prioritizing his running career, and doing the hardest thing possible (19:00);
Career transition to journalism, tips for improving your writing, and insights from the best writers (26:00);
Breaking down VO2 max: Definition, history, why it plateaus, and whether it really matters (38:15);
The case study of Oskar Svensson: Why a higher VO2 Max isn’t always better, and the difference between maximum aerobic capacity and efficiency (49:15);
The sub 2-hour marathon: The amazing feat by Kipchoge, and what will it take to “officially” run a 2-hour marathon (1:01:00);
Comparing the greatest mile runners from the 1950s to today (1:14:45);
How the brain influences the limits of endurance (1:20:15);
Relationship between exercise volume and health: Minimum dose, optimal dose, and whether too much exercise can shorten lifespan (1:23:45);
Age-associated decline in aerobic capacity and muscle mass, and the quick decline with extreme inactivity (1:40:45);
Strength or muscle mass—which is more important? (1:47:00);
Avoiding acute and chronic injuries from exercise (1:48:45);
High intensity interval training: Evolution of the Tabata protocol, pros and cons of HIIT training, and how it fits into a healthy exercise program (1:54:15);
The importance of understanding why you are engaging in exercise (2:03:00);
How we can encourage better science journalism and reduce the number of sensationalized headlines (2:05:45); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/AlexHutchinson Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#150 - Senator Bill Frist, M.D.: A modern Renaissance man's journey through science, politics, and business Feb 22, 2021

Bill Frist is a nationally acclaimed heart and lung transplant surgeon, former U.S. Senate Majority Leader, and is actively engaged in health policy and education reform. In this episode, Bill takes us through his long and varied career in medicine, politics, and business, which includes establishing the organ transplantation program at Vanderbilt as well as rising from the lowest-ranked member of the U.S. Senate to the Majority Leader in two terms. We discuss some of the most significant moments of his time in the Senate, such as advocating for AIDS prevention programs' funding and addressing complicated issues like stem cell research and the end-of-life issues raised by the Terri Schiavo case. We also hear his first-person account of what happened behind the scenes on September 11, 2001, his frustration with our lack of preparation for the pandemic, and his thoughts about the current state of U.S. politics. Finally, we talk about his current endeavors in health policy and education reform.

We discuss:

Bill’s decision to pursue medicine and do organ transplants (3:40);
The miraculous nature of organ transplants: History, Bill’s work, and the most exciting things to come (12:00);
Frist’s experience building up the heart transplant program at Vanderbilt (21:45);
The famous rivalry between surgeons Denton Cooley and Michael DeBakey (29:15);
How the medical field can attract bright young people to pursue medicine (33:00);
Bill’s decision to leave medicine and run for the US senate (38:00);
The value in having scientists and physicians in Congress (47:30);
A discussion on whether or not senators should have term limits (55:30);
The highly polarized nature of politics, and how we can fix it with empathy (1:00:30);
Bill’s time in the Senate and quick rise to Senate Majority Leader (1:05:30);
The lifesaving impact of the President's Emergency Plan for AIDS Relief (PEPFAR) under George W. Bush (1:15:15);
How Bill reversed course on his view of the value and morality of stem cell research (1:19:45);
Complex end-of-life decisions, and Bill’s role in the infamous Terri Schiavo case—a story that captures the conflict among law, morality, and improving technology (1:30:00);
Remembering the events of September 11th from Bill’s perspective in the Senate (1:49:45);
The coronavirus pandemic: Bill’s accurate 2005 prediction, and a discussion about future preparedness (1:56:45);
The divided state of US politics, and how we can come together (2:06:45);
How experience in medicine and politics is shaping Bill’s current endeavors in business, reforming education, palliative care, and more (2:12:45); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/BillFrist Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#149 - AMA #20: Simplifying the complexities of insulin resistance: how it's measured, how it manifests in the muscle and liver, and what we can do about it Feb 15, 2021

In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss all things related to insulin resistance by revisiting the important points made in the fascinating, yet quite technical, episode of The Drive with Gerald Shulman. They devote the entire discussion to understanding the condition known as insulin resistance, how it’s measured, how it manifests in the muscle and liver, and ultimately, what we can do about it.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #20 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Explaining the format of this AMA: Extracting insights from Gerald Shulman’s masterclass on insulin resistance (2:00);
The basics of insulin, defining insulin resistance (IR), and gold-standard methods of quantifying IR in the muscle (7:15);
Practical ways to test for insulin resistance in a normal clinical setting (15:45);
How insulin resistance manifests in the muscle (23:00);
The biochemical block in glycogen synthesis—drivers and mechanisms resulting in insulin resistance in the muscle (30:45);
The disparity in fat oxidation between insulin-sensitive and insulin-resistant individuals (44:45);
The fate of the ingested carbohydrate in someone who is insulin resistant (51:00);
The prevalence and clinical phenotype of insulin resistance (1:00:15);
The role of exercise in mitigating and reversing insulin resistance (1:05:00);
How insulin resistance manifests in the liver (1:09:15);
Biggest takeaways: what we can do to mitigate and prevent insulin resistance (1:20:45); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama20/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#148 - Richard Miller, M.D., Ph.D.: The gold standard for testing longevity drugs: the Interventions Testing Program Feb 08, 2021

Richard Miller is a professor of pathology and the Director of the Center for Aging Research at the University of Michigan. He is one of the architects of the NIA-funded Interventions Testing Programs (ITPs) animal study test protocol. In this episode, Rich goes through the results of the long list of molecules tested by the ITP—including rapamycin, metformin, nicotinamide riboside, an SGLT-2 inhibitor called canagliflozin, and more. Many of the discussed outcomes have had surprising outcomes—both positive and negative findings.

We discuss:

Rich’s interest in aging, and how Hayflick’s hypothesis skewed aging research (3:45);
Dispelling the myth that aging can’t be slowed (15:00);
The Interventions Testing Program—A scientific framework for testing whether drugs extend lifespan in mice (29:00);
Testing aspirin in the first ITP cohort (38:45);
Rapamycin: results from ITP studies, dosing considerations, and what it tells us about early- vs. late-life interventions (44:45);
Acarbose as a potential longevity agent by virtue of its ability to block peak glucose levels (1:07:15);
Resveratrol: why it received so much attention as a longevity agent, and the takeaways from the negative results of the ITP study (1:15:45);
The value in negative findings: ITP studies of green tea extract, methylene blue, curcumin, and more (1:24:15);
17α-Estradiol: lifespan effects in male mice, and sex-specific effects of different interventions (1:27:00);
Testing ursolic acid and hydrogen sulfide: rationale and preliminary results (1:33:15);
Canagliflozin (an SGLT2 inhibitor): exploring the impressive lifespan results in male mice (1:35:45);
The failure of metformin: reconciling negative results of the ITP with data in human studies (1:42:30);
Nicotinamide riboside: insights from the negative results of the ITP study (1:48:45);
The three most important takeaways from the ITP studies (1:55:30);
Philosophies on studying the aging process: best model organisms, when to start interventions, which questions to ask, and more (1:59:30);
Seven reasons why pigs can't fly (2:08:00); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/RichardMiller Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#147 - Hussein Yassine, M.D.: Deep dive into the “Alzheimer’s gene” (APOE), brain health, and omega-3s Feb 01, 2021

Hussein Yassine is a physician and researcher who studies brain lipid utilization in the context of finding preventative measures for cognitive impairment, specifically Alzheimer’s disease (AD). In my conversation with Hussein, we begin with a fundamental coursework in brain biology—including its architecture and energy systems. We go on to discuss what these systems look like when something goes wrong and cognitive decline ensues. We talk about the evolutionary origins of the ApoE genotype, with specific attention to the ApoE4 allele and its association with AD. We spend time discussing ApoE4 implications for the brain’s fuel utilization, notably omega-3 fatty acids: EPA and DHA. We briefly pivot to the implications of recent omega-3 trials for cardiovascular disease and return to what we currently understand about EPA/DHA and brain health; we contemplate potential dietary interventions across the lifespan to preserve and prolong cognitive function.

We discuss:

Hussein’s Background and introduction to brain composition (3:00);
The blood-brain barrier and brain filtration (8:00);
Lipids and brain function (13:00);
How the brain utilizes energy (18:00);
Apolipoprotein E (ApoE) structure and function in the periphery (27:30);
ApoE function in the brain (38:15);
Evolutionary origins of ApoE isoforms (43:45);
ApoE4 variant and Alzheimer’s disease (AD) risk (53:30);
Dietary fuel preference with the ApoE4 allele (1:03:00);
The role of omega-3 fatty acids in the brain (1:13:30);
Comparing findings from the REDUCE-IT and STRENGTH trial (1:21:45):
The relationship between dietary omega-3 intake and brain health (1:34:15);
Preventing cognitive decline: A critical window for DHA in ApoE4 carriers? (1:42:30);
Hussein’s ongoing research and recommendations for E4 carriers (1:54:00); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/HusseinYassine Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#146 - Guy Winch, Ph.D.: Emotional first aid and how to treat psychological injuries Jan 25, 2021

Guy Winch is a psychologist, author, and co-host of the Dear Therapist podcast. In this episode, Guy speaks to the commonality of the human condition with relatable stories from his decades of therapy sessions as well as his own experience with incessant rumination in the early days of his private practice. He shares insights on what he sees as an epidemic of rumination that leads to career burnout, the consequences of social comparison heightened by social media, and the psychological impact of not recognizing success. He emphasizes the need for a “psychological medicine cabinet” and provides concrete and practical tools for treating emotional injuries. He concludes with a discussion about the widespread impact of the coronavirus pandemic on emotional health and how we can use experienced psychologists in a time when it’s especially needed.

We discuss:

The unique format and impetus for Guy’s podcast with Lori Gottlieb (3:00);
How Guy pieced together the many different schools of thought in psychology to develop his own unique approach (7:45);
The most important component of successful therapy, and why it sometimes makes sense to “break the rules” (19:30);
Insights extracted from Guy’s own battle with extreme stress and anxiety around finishing his education and starting his private practice (28:15);
The epidemic of rumination, burnout, and the inability to psychologically leave work (34:15);
Antidotes to incessant rumination, and tips for transitioning from work to home to avoid burnout (41:15);
The psychology of complaining: The hidden cost of complaining incorrectly and benefits of learning how and when to complain (52:30);
The consequences of social comparison, and the impact of “failure” on emotional health (1:02:15);
How Guy helps people who struggle to acknowledge any level of success (1:07:30);
Emotional first aid: The importance of a psychological medicine cabinet for treating emotional injuries (1:19:00);
The role of therapists in normalizing the discussion of emotional injuries and illuminating the commonality of feelings (1:27:45);
The widespread impact of the coronavirus pandemic on emotional health (1:35:15);
How to properly use affirmations—a tool for treating psychological injuries (1:42:00);
The importance of nuanced language and the stories we tell ourselves (1:47:30);
Peter’s favorite episode of the Dear Therapist Podcast (1:53:15); and
More.

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#145 - AMA #19: Deep dive on Zone 2 training, magnesium supplementation, and how to engage with your doctor Jan 18, 2021

In this “Ask Me Anything” (AMA) episode, Peter and Bob take a deep dive into zone 2 training. They begin with a detailed definition of zone 2 and continue by discussing the importance of adding it to your exercise regimen. They talk about how to program zone 2 training, including intensity, frequency, and duration, and metrics for tracking improvement. Additionally, they provide a detailed overview of all things related to magnesium supplementation. The two conclude with insights about how to effectively engage with your doctor in the pursuit of getting your questions answered and considerations for finding a physician that’s right for you.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #19 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Defining zone 2 exercise (3:30);
The most effective ways to engage in zone 2 exercise (14:00);
The process of training a deconditioned individual with zone 2: Dosage, frequency, and metrics to watch (19:45);
Training for health vs. performance, and the importance dedicating training time solely to zone 2 (25:00);
Why Peter does his zone 2 training in a fasted state (31:30);
Improving mitochondrial density and function with zone 2 training (34:00);
Metrics to monitor improving fitness levels from zone 2 training (36:30);
Advice for choosing a bicycle for zone 2 exercise at home (42:30);
Comparing the various equipment options for aerobic training: Rowing machine, treadmill, stairmaster, and more [48:15];
Back pain and exercise, and Peter’s stability issues as a consequence of previous surgeries (51:45);
A deep dive into magnesium supplementation, and Peter’s personal protocol (55:30);
Advice for engaging with and questioning your doctor (1:03:15); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama19 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#144 - Phil Maffetone: Optimizing health and performance through maximal aerobic function Jan 11, 2021

Phil Maffetone is an author, health practitioner, and coach with decades of experience helping everyone from amateurs to world-class athletes optimize their health and performance. In this episode, Phil explains the importance of developing the aerobic system, defines maximum aerobic function (MAF), and explains how to determine your MAF heart rate. He then demonstrates how to integrate that into a training protocol which is designed to help people move faster at a sub maximum heart rate and increase fat utilization as the primary source of fuel—emphasizing the importance of nutrition on one's capacity to oxidize fat. Phil also extracts training insights from the amazing feats of world-class marathoners, explores the impact of a low-carb diet on one’s capacity for high intensity exercise and anaerobic performance, and explains the downstream effects of being “overfat.”

We discuss:

Phil’s background in running, and training insights from a six-day race (2:30);
The difference between being “fit” and being “healthy” (11:00);
Defining the aerobic and anaerobic systems, and why VO2 max doesn’t predict performance (18:15);
Defining maximum aerobic function (MAF), determining your MAF heart rate with Phil’s 180 Formula, and why a strong aerobic system is crucial to health and performance (24:00);
Using the MAF test to track and improve your aerobic fitness (37:30);
How increasing your sub-max pace at a given heart rate can increase your maximum pace (40:00);
The impact of nutrition on one’s ability to use fat as fuel while exercising (43:00);
Phil’s nutritional approach with patients, the concept of “carbohydrate intolerance” (51:45);
Assessing the impact of a low-carb diet on high intensity exercise and anaerobic performance (58:00);
Extracting insights from world-class marathoners (1:04:45);
How being “overfat” affects health and performance, and ways to decrease excess body fat (1:13:30); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: http://peterattiamd.com/PhilMaffetone Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#143 - John Ioannidis, M.D., D.Sc.: Why most biomedical research is flawed, and how to improve it Jan 04, 2021

John Ioannidis is a physician, scientist, writer, and a Stanford University professor who studies scientific research itself, a process known as meta-research. In this episode, John discusses his staggering finding that the majority of published research is actually incorrect. Using nutritional epidemiology as the poster child for irreproducible findings, John describes at length the factors that play into these false positive results and offers numerous insights into how science can course correct. We discuss:

John’s background, and the synergy of mathematics, science, and medicine (2:40);
Why most published research findings are false (10:00);
The bending of data to reach ‘statistical significance,’ and the how bias impacts results (19:30);
The problem of power: How over- and under-powered studies lead to false positives (26:00);
Contrasting nutritional epidemiology with genetics research (31:00);
How to improve nutritional epidemiology and get more answers on efficacy (38:45);
How pre-existing beliefs impact science (52:30);
The antidote to questionable research practices infected with bias and bad incentive structures (1:03:45);
The different roles of public, private, and philanthropic sectors in funding high-risk research that asks the important questions (1:12:00);
Case studies demonstrating the challenge of epidemiology and how even the best studies can have major flaws (1:21:30);
Results of John’s study looking at the seroprevalence of SARS-CoV-2, and the resulting vitriol revealing the challenge of doing science in a hyper-politicized environment (1:31:00);
John’s excitement about the future (1:47:45); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/JohnIoannidis Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#142 - Robert Abbott: The Bobby Knight story—a cautionary tale of unchecked anger, ego, and winning at all costs Dec 21, 2020

Robert Abbott is a six-time Emmy award winner and the director of “The Last Days of Knight,” the behind-the-scenes documentary of legendary coach Bobby Knight, and the events that led to his termination from Indiana University. In this episode, Robert takes us through his investigative journey, which revealed cautionary tales of a winning at all costs environment—how pain often gets left in the wake of unchecked anger, ego, and perfectionism. Robert reflects on Knight’s legacy and extracts lessons in self-awareness and accountability that can be applied to ensure history doesn’t repeat itself.

We discuss:

Robert’s career covering sports and interesting athletes (2:30);
Robert’s early impression of Bobby Knight’s controversial persona (10:15);
The journalistic work that uniquely prepared Robert for his Bobby Knight story (13:30);
The cost of excellence in sports—cautionary tales of ‘greatness at any cost’ (19:15);
Knight’s coaching style, waning success in the 90s, and what put him on Robert’s radar (25:30);
Three alarming accounts from a former player (Neil Reed) that launched Robert’s investigation into Bobby Knight (35:15);
The “win-first” environment at Indiana that provided cover for Knight’s toxic behavior (44:45);
Knight’s ego swells—a shift from team-first to “I” and “me” (53:00);
How patience, honesty, and gaining trust with his sources paid off in his reporting on Bobby Knight (1:01:30);
The vicious cycle and anger and shame, and why Bobby Knight is so interesting to Peter (1:08:00);
Releasing the choking tape—Breaking open the Knight story, vindicating his earlier reporting, and the most powerful moment Robert has ever witnessed in his journalistic career (1:20:00);
The bittersweet story of Neil Reed—triumph, PTSD, and breaking the cycle of pain (1:43:15);
Examining Bobby Knight's legacy, and how society can avoid a repeat of similar devastating situations (1:57:30);
Final thoughts on Bobby Knight and the pain left in his wake (2:08:00); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/RobertAbbott Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#141 - AMA #18: Deep dive: sugar and sugar substitutes Dec 14, 2020

In this “Ask Me Anything” (AMA) episode, Peter and Bob talk all about sugar and sugar substitutes and provide a way to think about sugar consumption. The conversation begins by defining the various forms of sugar, delineating between added sugar and naturally occurring sugar, and describing the important variables that determine the potential for metabolic damage from consumption. They then take a dive deep into three main categories of sugar substitutes—non-nutritive sweeteners, alcohol sugars, and leaving allulose, in a class by itself—including the safety profile of each, impact on blood sugar and insulin, side-effects, taste preferences, and more.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #18 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Delineating the various forms of “sugar” (2:00);
Added sugar vs. naturally occurring sugar (12:30);
Important variables related to sugar consumption: Density, volume, and velocity (17:00);
Alternatives to sugar: Non-nutritive sweeteners (22:30);
Alternatives to sugar: Alcohol sugars (34:15);
Alternatives to sugar: Allulose (39:00);
Contextualizing risk when it comes to sugar substitutes (45:00);
Why some people report feeling better when eliminating non-nutritive sweeteners from their diet (46:30);
The impact of sweetness—Cephalic insulin response and the metabolic drive to eat more (49:45); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama18/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#140 - Gerald Shulman, M.D., Ph.D.: A masterclass on insulin resistance—molecular mechanisms and clinical implications Dec 07, 2020

Gerald Shulman is a Professor of Medicine, Cellular & Molecular Physiology, and the Director of the Diabetes Research Center at Yale. His pioneering work on the use of advanced technologies to analyze metabolic flux within cells has greatly contributed to the understanding of insulin resistance and type 2 diabetes. In this episode, Gerald clarifies what insulin resistance means as it relates to the muscle and the liver, and the evolutionary reason for its existence. He goes into depth on mechanisms that lead to and resolve insulin resistance, like the role of diet, exercise, and pharmacological agents. As a bonus, Gerald concludes with insights into Metformin’s mechanism of action and its suitability as a longevity agent.

We discuss:

Gerald’s background and interest in metabolism and insulin resistance (4:30);
Insulin resistance as a root cause of chronic disease (8:30);
How Gerald uses NMR to see inside cells (12:00);
Defining and diagnosing insulin resistance and type 2 diabetes (19:15);
The role of lipids in insulin resistance (31:15);
Confirmation of glucose transport as the root problem in lipid-induced insulin resistance (40:15);
The role of exercise in protecting against insulin resistance and fatty liver (50:00);
Insulin resistance in the liver (1:07:00);
The evolutionary explanation for insulin resistance—an important tool for surviving starvation (1:17:15);
The critical role of gluconeogenesis, and how it’s regulated by insulin (1:22:30);
Inflammation and body fat as contributing factors to insulin resistance (1:32:15);
Treatment approaches for fatty liver and insulin resistance, and an exciting new pharmacological approach (1:41:15);
Metformin’s mechanism of action and its suitability as a longevity agent (1:58:15);
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/geraldshulman Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#139 - Kristin Neff, Ph.D.: The power of self-compassion Nov 30, 2020

Kristin Neff is a Professor of Educational Psychology at the University of Texas, author, and a leading expert on mindful self-compassion. In this episode, she shares how developing a self-compassion and mindfulness practice was the most effective tool for relieving her own suffering, and provides strategies and tactics to improve self-compassion and well-being.

We discuss:

The life crisis that turned Kristin to mindfulness and self-compassion (3:30);
How mindful self-compassion relieved Kristin’s feelings of self-judgement, and the psychology that says we all have the capacity for self-compassion (9:45);
Peter’s history of self-criticism and his personal practice of self-compassion (17:15);
The problem with prioritizing self-esteem over self-compassion, and how self-compassion produces a more stable version of self-worth (20:15);
An argument for self-compassion over self-criticism for optimizing performance (26:15);
How and when to introduce self-compassion to children (31:45);
Learning her son had autism—a personal story of how Kristin used mindfulness and self-compassion (36:45);
Self-compassion for cases of childhood trauma, PTSD, and overcoming a “fear of compassion” (44:00);
The relationship between self-compassion and physical health (49:30);
Distinguishing between self-compassion and self-pity, and the three necessary components self-compassion (52:30);
Why self-criticism comes from a desire to be safe, the circular pattern of self-judgment, and self-compassion as the ultimate motivator (55:45);
Potential role of a self-compassion practice for addiction and other maladaptive behaviors (58:45);
Clinical applications and practical uses of self-compassion (1:01:30);
Why you don’t need to meditate to learn mindfulness and self-compassion (1:04:45);
Kristin’s personal meditation practice (1:08:40);
Resources for learning self-compassion (1:11:45); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/kristinneff Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#138 - Lauren Miller Rogen and Richard Isaacson, M.D.: Alzheimer’s disease prevention—patient and doctor perspectives Nov 23, 2020

Peter is joined by writer, director, actress, and founder of HFC, Lauren Miller Rogen, and previous podcast guest and director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian, Dr. Richard Isaacson. In this episode, Lauren tells the heartbreaking story of watching members of her family succumb to Alzheimer’s disease (AD) which motivated her to proactively address her own risk with Richard’s guidance. Richard discusses the various genetic and lifestyle factors that influence the risk of AD and uses Lauren’s unique situation to explain how he diagnoses patients and personalizes care. They go through Lauren’s protocol of preventative measures that have already produced marked results, and end with the uplifting message that one’s genetic predisposition does not seal one's fate.

We discuss:

Lauren’s deep family history of Alzheimer’s disease (3:10);
The influence of genetics, epigenetics, and lifestyle on Alzheimer’s disease risk (13:45);
Lauren’s mother’s disease progression and the enormous stress it causes for family members (24:30);
The various manifestations of Alzheimer’s disease depending on the location of pathology (29:30);
The three stages of Alzheimer's disease (34:45);
Richard’s deep exploration into Lauren’s family history revealing clues about a diagnosis and a roadmap to successful disease mitigation (39:15);
How exercise reduces Alzheimer’s disease risk, and the different risk between males and females (58:00);
Why knowing your APOE status is important, and whether certain people should be wearier of head trauma (1:08:00);
How Richard uses genetic testing to personalize care (1:14:45);
The “ABCs” of Alzheimer’s prevention, lifestyle interventions, and Lauren’s personal protocol for reducing her risk (1:21:45);
Unique treatment for people with the ApoE4 variant (1:36:30);
Richard’s mixed opinion on CBD and THC as a tool for disease prevention (1:40:00);
Cognitive testing procedures, and how Lauren’s tests furthered her commitment to her disease prevention protocol (1:41:45);
The relevance of sense of smell and hearing in Alzheimer’s disease risk and prevention (1:50:00);
The emotional benefit of knowing you have control over your mental and physical health (1:57:30);
HFC—a charitable organization founded by Lauren and Seth (2:00:15); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/laurenmillerrogen-richardisaacson/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#137 - Paul Offit, M.D.: An expert perspective on COVID-19 vaccines Nov 16, 2020

Paul Offit is a pediatrician specializing in infectious diseases and an expert in virology and vaccine development. He currently serves on the FDA committee overseeing and evaluating COVID-19 vaccines. In this episode, Paul discusses the strategies and major companies pursuing a vaccine against the SARS-CoV-2 virus. He gets into the nuances of the vaccine approval process and its implications for COVID-19 vaccine outlook. Paul also explains potential risks, reveals his own confidence level in safety, and gives insight into protection against reinfection with vaccination. Please note that this episode was recorded 11/05/2020, prior to the 11/09/2020 news release of the Pfizer vaccine update. We discuss:

How Paul’s experience as a child in a chronic care hospital as child informed his path in pediatrics and vaccine development (3:30);
Addressing the anti-vaccination sentiment and explaining the fraudulent origins of the anti-vaccination movement (8:00);
Lessons and insights from 26 years studying rotavirus and creating a successful rotavirus vaccine (17:00);
Developing a new vaccine: the different phases of clinical trials, overall timeline, and financial costs (27:15);
Operation Warp Speed: the expedited process of creating a coronavirus vaccine (32:30);
Various vaccine strategies—RNA, DNA, virus vector—and the challenges associated (35:00);
The Moderna and Pfizer mRNA vaccines: strategy, timeline, and Emergency Use Authorization (41:15);
Paul’s confidence level in the safety of the first coronavirus vaccines (48:30);
The risks associated with different types of vaccines, and updates on the Johnson & Johnson and Astrazeneca coronavirus vaccines (52:15);
What we know about the coronavirus vaccines approved in Russia and China (55:45);
The latest on the Merck coronavirus vaccine (57:15);
The recombinant/purified protein vaccine approach for coronavirus—big players, risks, and the best vaccine for the elderly (57:45);
Attenuated and inactivated vaccine strategies for coronavirus (1:02:00);
The genetic drift of SARS-CoV-2: Impacts for protection and vaccine development (1:02:30);
Paul’s take on the hypothesis that a previous coronavirus infection offers protection against the novel COVID-19 (1:06:45);
Addressing the concern that antibodies fade over time (1:09:15);
Blood type and protective against coronavirus (1:13:00);
Distribution: the challenge of prioritizing the limited doses of vaccines after approval (1:13:15);
Paul’s perspective on COVID-19 vaccine safety (1:16:15);
Considerations regarding vaccinating children for coronavirus and the role of a fever immune response (1:21:45);
Why vaccine development can be challenging and risks of current COVID-19 strategies (1:29:45); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/pauloffit Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#136 - AMA #17: Body composition methods tour de force, insulin resistance, and Topo Chico Nov 09, 2020

In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss different methods to evaluate body composition. They explore ways of measuring body fat, delineating between subcutaneous and visceral fat, and go over best strategies for improving body composition and optimizing health. They also discuss insulin resistance using a patient case study that highlights interventions capable of reversing the condition. Finally, Peter addresses his level of concern about a recent Consumer Report finding that Topo Chico had the highest levels of a class of synthetic chemicals (PFAS) of all the carbonated bottled waters tested. Peter concludes by sharing if the finding will change his consumption habits. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #17 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss:

Body mass index (BMI) vs. body fat percentage (BF%) (1:45);
Methods of assessing body fat—Magnetic Resonance Imaging (MRI) (6:25);
The different types of body fat (9:00);
Methods of assessing body fat—Computed Tomography (CT Scan) (12:00);
Methods of assessing body fat—Dual-Energy X-ray Absorptiometry (DEXA) (14:30);
Methods of assessing body fat—Hydrostatic/Underwater Weighing (19:25);
Methods of assessing body fat—Air Displacement (Bod Pod) (22:25);
Methods of assessing body fat—Skinfold measurement (23:55);
Methods of assessing body fat—Total Body Water (27:15);
Methods of assessing body fat—Bioelectrical Impedance (BIA) (28:45);
The optimal body fat percentage, muscle mass, and the best strategy to improve body composition (31:30);
Defining insulin resistance and the steps to reverse it (40:15);
Patient case study: Reversing insulin resistance (49:00);
Addressing the recent finding of high levels of PFOA in Topo Chico (58:25); and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama17 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#135 - BJ Miller, M.D.: How understanding death leads to a better life Nov 02, 2020

BJ Miller is a hospice and palliative care specialist on a quest to reframe our relationship with death. In this episode, BJ begins with how his own brush with death radically shifted his perspective and ultimately forged his path towards palliative care and helping patients integrate and understand their life in a meaningful way. BJ recounts several moving stories from his patients, which reveal important lessons about overcoming the fear of death, letting go of regret, and what’s most important in life. He discusses the major design flaws of a “death phobic” healthcare system. Furthermore, he makes the case that seeing death as a part of life allows us to live well, as opposed to living to evade death itself. He concludes with a discussion around physician-assisted death as well as his hopes around the use of psychedelics to reduce suffering in end-of-life care. We discuss:

BJ’s accident leading to the loss of his limbs and his experience inside a burn unit [3:00];
Coping with his amputations—being tough, the grieving process, and the healing properties of tears [14:30];
Going from art history to medical school: the value of a diverse background in medicine [28:15];
How BJ’s new body liberated him [40:00];
How losing his sister to suicide and his disillusionment with medicine altered his path [47:15];
Discovering his path of palliative care—distinct from hospice—in medicine [55:30];
Our complicated relationship with death, and how acknowledging it can release its grip and improve living [1:02:15];
The different distinctions around the fear of death, and how BJ helps his patients negotiate fears [1:10:00];
The major design flaws of a “death phobic” healthcare system [1:14:15];
Common regrets, the value of time, and other insights from interactions with patients in their final moments of life [1:23:00];
The story of Randy Sloan—a case study of playing life out [1:33:45];
Physician-assisted dying: Legality and considerations [1:39:45];
The use of psychedelics in end-of-life care, and what BJ is most excited about going forward [1:45:45]; and
More.

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#134 - James O’Keefe, M.D.: Preventing cardiovascular disease and the risk of too much exercise. Oct 26, 2020

James O’Keefe is a preventative cardiologist and bestselling author of The Forever Young Diet and Lifestyle. In this episode, James discusses cardiac physiology and what makes the human heart susceptible to disease. He provides evidence for what supports his approach to exercise--elucidating both positive and negative kinds of exercise for heart health. He also discusses the role of nutrition, specific nutrients, and pharmacological interventions to support heart and brain longevity.

We discuss:

James’ background and why he favors a preventative approach to cardiology [3:15];
Understanding atherosclerosis and the misconception that it’s a “plumbing problem” [10:15];
The danger in excessive exercise—a reverse J-shaped mortality curve [21:15];
The story of Micah True—A case study of excessive exercise [49:15];
The best kinds of exercise for longevity—The Copenhagen City Heart Study [53:00];
Being a more balanced athlete and finding the right exercise intensity [58:45];
Heart rate during exercise, resting heart rate, and other important metrics [1:04:00];
Nutrition for cardiovascular health [1:09:45];
Important nutrients: Magnesium, potassium, calcium, sodium, and collagen [1:19:30];
SGLT2 inhibition for diabetes, cardio-protection, and general longevity [1:24:15];
GLP-1 agonists for weight loss and reducing cardiovascular risk [1:34:15];
Statins—Mechanism of action, safety, and useful alternatives [1:37:25];
A 40-year view on cardiovascular risk, and the possibility of reversing arterial calcification [1:45:45];
Evidence for high dose EPA and DHA for the reduction of cardiovascular disease risk [1:53:30];
The impact of omega-3, curcumin, and other compounds on mental health and dementia [1:59:00];
James’ focus beyond cardiology [2:02:15]; and
More.

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#133 - Vinay Prasad, M.D., M.P.H: Hallmarks of successful cancer policy Oct 19, 2020

Vinay Prasad is a practicing hematologist-oncologist who doubles as a “meta-researcher,” studying the quality of medical evidence, health policy, and clinical trials. In this episode, Vinay discusses the differences in clinical treatment from the existing medical evidence, often leading to useless, or even harmful, outcomes for patients. With a focus in oncology, he takes a deep dive into the field’s structural problems, which include the disconnect between progress and funding, drug costs, and financial conflicts of interest. He concludes with his “six hallmarks of successful cancer policy” as a potential roadmap to sustained progress against cancer and a way to avoid repeating the policy and practice mistakes of the past.

We discuss:

Vinay’s background and unique perspective [3:15];
Medical reversal—the disconnect between research findings and clinical applications in medicine [10:15];
The uniquely challenging field of oncology [22:45];
The importance of bedside manner with cancer patients [30:00];
Structural problems in oncology—Problem #1: Huge costs for small improvements [37:00];
Structural problems in oncology—Problem #2: Medical reversal—when medical practices are adopted based on low levels of evidence [40:15];
Structural problems in oncology—Problem #3: Slow progress in cancer research (despite all the hype and propaganda) [45:00];
Structural problems in oncology—Problem #4: The burden of payment is not matched with those making treatment decisions [54:45];
“No-brainer” moves in oncology [1:06:45];
“Fool’s gold” treatments in oncology [1:09:30];
The six hallmarks of successful cancer policy [1:16:00];
Cancer policy hallmark #1: Independence [1:18:00];
Cancer policy hallmark #2: Evidence [1:28:15];
Cancer policy hallmark #3: Relevance [1:31:30];
Cancer policy hallmark #4: Affordability [1:32:00];
Cancer policy hallmark #5: Possibility [1:47:00];
Cancer policy hallmark #6: Agenda [1:52:00];
Tumor genome sequencing and liquid biopsies [1:54:30];
Vinay’s clinical philosophy, being skeptical without being too contrarian, and practicing medicine without perfect information [2:03:30]; and
More.

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#132 - AMA #16: Exploring hot and cold therapy Oct 12, 2020

In this “Ask Me Anything” (AMA) episode, Peter and Bob explore the quality of evidence for hot and cold therapy. In the discussion, they evaluate the safety, efficacy, and opportunity costs of various hot and cold therapy protocols, and Peter ultimately considers the addition of dry sauna to his longevity toolkit. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #16 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

How stress can show up as physical pain, and tips for changing time zones [1:45];
Literature overview of heat and cold therapy [7:15];
Cold therapy for delayed onset muscle soreness (DOMS) [12:00];
Quality of evidence for cold therapy for depression or immune enhancement [19:30];
Cold therapy and brown adipose tissue (BAT) [21:15];
Weighing the safety, efficacy, and opportunity cost of cold therapy [28:45];
An overview of heat therapy benefits [40:00];
Longevity benefits of sauna—reviewing the studies [41:30];
Limitations in the sauna literature—Where might we be fooled? [54:30];
Possible mechanisms conferring the longevity benefits of sauna, and how it compares to exercise [1:02:15];
Parting thoughts on sauna, opportunity costs, and Bob’s personal regimen [1:06:30]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama16/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#131 - Beth Lewis: The Art of Stability: Learning about pain, mitigating injury, and moving better through life Oct 05, 2020

Beth Lewis is a former professional dancer and a self-described “educator of movement” who has an unmatched ability to assimilate information and customize training plans from multiple training systems. In this episode, Beth takes us through how she identifies problematic movement patterns and postures to help individuals relieve pain, avoid injury, and move better within all types of exercise. She explains how movement is in fact a trainable skill and provides suggestions for what people can add to their exercise routine to benefit their health and longevity.

We discuss:

Beth’s “way of no way” training philosophy [4:45]
Beth’s background in dancing and how she ended up in New York City [7:30]
Beth’s transition to fitness coaching and how her training philosophy has evolved [12:45];
Functional Range Conditioning and scapular mobility [21:50];
An overview of Postural Restoration Institute and Peter’s squat assessment [35:30];
The important connection between the ribs and breathing [39:45];
The role of sitting and external stress in chronic muscular tension [42:30];
The important role of your toes, minimalist footwear, and toe yoga [44:30];
Dynamic Neuromuscular Stabilization (DNS) [48:30];
A different view on knee valgus [52:45];
Is there such a thing as “bad posture”? [56:30];
How Beth identifies an issue, addresses it, and keeps clients motivated [58:45];
Lifting weights, the Centenarian Olympics, and dancing into old age [1:11:00];
The importance of the hamstrings versus abs [1:21:15];
Benefits of rowing, and why everyone should add it to their exercise regimen [1:27:15]
Different roles of concentric versus eccentric strength [1:35:15];
Flexibility and high-intensity interval training (HIIT) [1:39:40];
Training versus playing sports, and the best type of activity for kids [1:43:00]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/bethlewis Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#130 - Carol Tavris, Ph.D. & Elliot Aronson, Ph.D.: Recognizing and overcoming cognitive dissonance Sep 28, 2020

Renowned social psychologists Carol Tavris and Elliot Aronson are the co-authors of Mistakes Were Made (But Not By Me), a book which explores the science of cognitive biases and discusses how the human brain is wired for self-justification. In this episode, Carol and Elliot discuss how our desire to reconcile mental conflicts adversely affects many aspects of society. The two give real-world examples to demonstrate the pitfalls in attempts to reduce mental conflict, or dissonance. The examples reveal that no one is immune to dissonance reduction behavior, how intellectual honesty can be trained and lastly, how to think critically in order to avoid engaging in harmful dissonant behaviors.

We discuss:

Carol and Elliot’s respective background, collaboration history, and their decision to write Mistakes Were Made (But Not By Me) [4:00];
The theory of cognitive dissonance, and real examples of dissonance reduction in action [11:15];
How Elliot advanced the theory of cognitive dissonance [23:00];
The evolutionary reason for dissonance reduction, and cultural differences in what causes cognitive dissonance [30:30];
The great danger of smart, powerful people engaging in dissonance reduction [35:15];
Two case studies of cognitive dissonance in criminal justice [39:30];
The McMartin preschool case study—The danger in making judgements before knowing all the information [43:30];
How ideology distorts science and public opinion [56:30];
How time distorts memories [58:30];
The downside of certainty [1:05:30];
Are we all doomed to cognitive dissonance?—How two people with similar beliefs can diverge [1:09:00];
Cognitive dissonance in the police force [1:21:00];
A toolkit for overcoming cognitive dissonance [1:27:30];
Importance of separating identity from beliefs, thinking critically, & and the difficulty posed by political polarity [1:30:30];
How to impart the lessons from their work into future generations [1:48:00]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/caroltavris-elliotaronson/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#129 - Tom Dayspring, M.D.: The latest insights into cardiovascular disease and lipidology Sep 21, 2020

World-renowned lipidologist Tom Dayspring returns to give an update on the current thinking in lipidology as a follow-up to his 2018 five-part podcast series. In this episode, Tom discusses the growing consensus that atherogenic lipoproteins are essential drivers of atherosclerotic vascular disease. Tom further emphasizes apolipoprotein B (apoB) and lipoprotein(a) (Lp(a)). He provides insights into risk assessment, including which lab metrics to use, how to interpret them, and the appropriate therapeutic targets. Additionally, Tom discusses the most recent developments in lipid-lowering drug therapies—from the continued evolution of PCSK9 inhibitors, to the latest understanding of EPA and DHA, and the most recent addition of bempedoic acid to the list of therapeutic agents.

We discuss:

The latest in the field of lipidology and cardiovascular disease [3:45];
Apolipoproteins—the key to understanding lipid biology [9:30];
ApoB as a preferred metric over LDL-P [16:30];
Therapeutic goals for apoB concentration [21:45];
Drivers of atherosclerosis [34:15];
Overview and current thinking on high density lipoproteins (HDLs)—Is it a useful metric? [37:00];
Lipoprotein(a)—the most dangerous particle you’ve never heard of [55:00];
Are low density lipoprotein triglycerides (LDL-TGs) a useful metric? [1:13:15];
Tom’s preferred lab measurements [1:17:45];
The latest in lipid-lowering therapies [1:21:30];
The different pathways among various lipid-lowering drugs [1:30:45];
The latest on EPA and DHA [1:38:15];
Fibrates—an underappreciated treatment for hypercholesterolemia [1:49:45] and;
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/tomdayspring6 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#128 – Irene Davis, Ph.D.: The evolution of the foot, running injuries, and minimalist shoes Sep 14, 2020

Irene Davis is the founding Director of the Spaulding National Running Center at the Harvard Medical School. In this episode, Irene describes how her research of biomechanics and clinical work with running injuries, as well as research by others, has shaped her views on maintaining body alignment and foot health. Irene discusses her argument for the role of modern footwear in running-related injuries and how minimalist footwear helps resolve the subsequent biomechanical issues.

We discuss:

Irene’s path to her Ph.D., her entry into physical therapy, and her interest in biomechanics [3:20];
How Irene’s thinking about the use of orthotics has changed [7:15];
The evolution of the human foot and the transition from walking to running [10:30];
The evolution of shoes and its impact on running injuries [17:30];
An overview of running injuries [26:00];
Cushioned running shoes, heel striking and impact forces [29:30];
Shin splints [33:45];
How heel strike patterns promotes knee stress through rate of loading [35:30];
The critical importance of exercise [42:15];
Impact forces and injury potential [45:45];
How shoe cushioning alters impact forces despite forefoot striking [49:00];
An overview of minimalist shoes [52:30];
Irene’s protocol for transitioning people out of orthotics [58:45];
Transitioning to minimalist shoes and a forefoot strike [1:05:30];
Foot muscle volume, minimalist shoes, and orthotics [1:07:00];
The recognition of the importance of foot strength in podiatry [1:09:45];
Minimalist shoes across the lifespan—from children to adults [1:12:30];
Why learning to forefoot strike on soft surfaces is not the best approach [1:20:00];
Knee valgus and factors related to knee injury [1:21:45];
IT band syndrome [1:28:30];
Physics and ground reaction forces [1:33:15];
Irene’s approach to retraining a runner’s gait [1:36:00];
Case study—How the transition to minimalist shoes decreased injury and improved performance [1:42:15];
Importance of proper movement patterns and the negative influence of our modern environment [1:45:30]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/irenedavis Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#127 - AMA #3 with sleep expert, Matthew Walker, Ph.D.: Fasting, gut health, blue light, caffeine, REM sleep, and more Sep 07, 2020

In this special episode, Matthew Walker returns for his third AMA episode to provide his expert insight into numerous sleep-related questions directly from listeners. He explains how he adjusted his hypotheses on topics like blue light and caffeine, and why he is more bullish on the importance of REM sleep. Matt also answers questions about sleep wearables, how fasting affects sleep, how sleep deprivation impacts gut health, and magnesium as a sleep aid. Finally, Matt reveals what he believes is the next evolution in sleep science and technology. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website on the show notes page.

We discuss:

Matt’s framework for changing his mind when faced with new information [1:30];
Blue light—How Matt shifted his thinking [5:45];
Caffeine—How Matt has adjusted his hypothesis [12:00];
REM sleep—Why Matt is more bullish on the importance of dream sleep [16:30];
How to increase REM sleep [27:30];
Sleep tracking wearables—criteria for evaluation, and why Matthew favors Oura [35:00];
Does the electromagnetic force of devices have any impact on sleep? [40:15];
The relationship between fasting and sleep [46:15];
Restless leg syndrome [58:10];
Magnesium supplementation as a sleep aid [1:03:00];
The relationship between sleep deprivation and gut health [1:08:30];
The next evolution in sleep science and technology [1:16:30];
Questions Matt would like to explore if money was no issue [1:24:15]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/matthewwalkerama3 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#126 – Matthew Walker, Ph.D.: Sleep and immune function, chronotypes, hygiene tips, and addressing questions about his book Aug 31, 2020

In this episode, sleep expert Matthew Walker returns by popular demand to dive deeper into many sleep-related topics, starting with what we’ve learned about sleep through the lens of the COVID-19 pandemic and how sleep impacts the immune system. He then covers topics such as how dreaming affects emotional health, the different sleep chronotypes, the best sleep hygiene tips, and the pros and cons of napping. Matthew finishes by addressing several of the errors that readers have pointed out in his book, Why We Sleep.

We discuss:

Three ways the coronavirus pandemic impacts sleep [3:30];
The importance of dreaming for emotional health, and how the coronavirus pandemic increases dreaming [11:45];
The impact of alcohol consumption on sleep quality and stress levels [20:00];
Sleep’s impact on the immune system and implications for a future COVID-19 vaccine [27:45];
What determines how much deep sleep and REM sleep you need? [36:30];
Pros and cons of napping, and insights from the sleep habits of hunter-gatherer tribes [42:15];
Sleep hygiene, wind-down routine, and tips for better sleep [56:45];
Understanding sleep chronotypes and how knowing yours can help you [1:06:00];
Night terrors in kids—what they are and why they happen [1:16:30];
Addressing errors found in Matt’s book, Why We Sleep [1:20:45]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/matthewwalker4 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#125 - John Arnold: The most prolific philanthropist you may not have heard of Aug 24, 2020

John Arnold is widely regarded as the greatest natural gas trader of all time, but in his late 30’s he walked away from it all and turned full-time philanthropist. He and his wife have committed to strategically give away most of their vast fortune in their lifetime and are already doing so at a staggering pace of nearly a half billion dollars a year. In this episode, John explains his quest to address the most challenging social programs plaguing the country, including criminal justice, health care policy, and K-12 education. John also shares self-identified attributes that contributed to his success in natural gas trading and how those same traits have translated to his philanthropic aspirations.

We discuss:

John’s background, upbringing, and early entrepreneurial tendencies [3:50];
John’s time and rise at Enron [16:45];
Characteristics that made John an exceptional natural gas trader and how they translate to his philanthropic work [27:30];
The collapse of Enron [35:00];
The success of John’s hedge fund, and his early interest in philanthropy [40:30];
The infamous 2006 trade that brought down Amaranth Advisors [55:45];
John’s analytical prowess and emphasis on fundamentals [1:02:15];
The decision to become a full-time philanthropist and the founding of Arnold Ventures [1:09:00];
Education—John’s quest to fundamentally change K-12 education [1:18:45];
Strategic philanthropy—preventing problems by attacking root causes and creating structural change [1:24:30];
The criminal justice system—structural changes needed to address mass incarceration, policing practices, and recidivism [1:31:45];
Re-imagining prisons to reduce recidivism [1:49:00];
US health care policy—John’s focus on drug prices, and the severe consequences of not making system changes [1:56:15];
Climate change—the bipartisan role of John’s foundation [2:13:45];
Advice for young adults interested in philanthropy [2:17:45]; and
More

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#124 - AMA #15: Real-world case studies—metabolic dysregulation, low testosterone, menopause, and more Aug 17, 2020

As a follow up to AMA #14 where Peter explained his framework for analyzing labs, this “Ask Me Anything” (AMA) episode focuses on a number of real-world case studies exploring metabolic dysregulation, low testosterone, menopause, hypothyroidism, elevated uric acid, and more. From the examples discussed, you can follow along how our clinical team goes about interpreting diagnostic measures and applying relevant research findings. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #15 show notes page.

We discuss:

Should you stop taking supplements before getting a lab test? [2:45];
Family history—Questions to ask and what to look for [5:30];
The purpose of an oral glucose tolerance test (OGTT) [12:15];
Case study—Insufficient muscle mass for proper glucose disposal [17:15];
Why hemoglobin A1c is a relatively unhelpful metric [24:00];
Case study—Exceeding carbohydrate tolerance [26:30];
Case study—Metabolic dysfunction and a framework for metabolic health [33:30];
Peter’s ideal tracking of metabolic health for all his patients [43:30];
Contrasting presentations of hypogonadism—Low free testosterone [45:00];
How sleep, exercise, and alcohol affect testosterone levels? [56:20];
Case study—Surprisingly fast onset of menopause [59:25];
Case study—Hypothyroidism and high cholesterol [1:07:00];
Case study—Elevated uric acid and hypertension [1:10:55]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama15 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#123 - Joan Mannick, M.D. & Nir Barzilai, M.D.: Rapamycin and metformin—longevity, immune enhancement, and COVID-19 Aug 10, 2020

In this episode, Joan and Nir discuss their extensive research into rapamycin (including the category of analogs to rapamycin known as rapalogs) and metformin, respectively. Based on his work with metformin, Nir shares how he believes it could be a pro-longevity drug and the clinical trial he’s leading to test this belief. Joan discusses her work with rapalogs, their ability to suppress the immune system as well as provide immune-enhancement, and the clinical trials she has led that inform her insights. We also talk about the potential beneficial roles of both metformin and rapamycin in reducing mortality from COVID-19, reducing the risk of neurodegenerative diseases, and delaying aging as well as its related diseases.

We discuss:

Joan’s career, interest in aging, and work with rapamycin analogs [3:45];
When Nir became convinced metformin could be a pro-longevity agent [15:00];
How metformin and rapamycin impact the hallmarks of aging and extend lifespan [24:15];
Enhancing the immune system with rapalogs and metformin [34:15];
Potential of metformin and rapamycin in reducing mortality from COVID-19 [41:30];
Insights from Joan’s studies investigating the immune-enhancing effects of rapalogs [59:30];
Vaccines and treatments strategies for COVID-19, and the likelihood of long-term immunity [1:08:15];
The potential role of rapalogs and metformin in neurodegenerative disease [1:14:30];
Nir’s TAME trial—primary objectives and latest updates [1:18:00];
Potential synergistic effect when combining metformin with rapamycin [1:25:45];
Why Peter stopped taking metformin and started taking rapamycin [1:27:30];
Story from Nir’s book that demonstrates the challenge of doing good scientific studies [1:37:30];
The biology of aging—epigenetic clocks, proteomics, and Nir’s centenarian data [1:42:00];
Joan’s dream experiment to test immune-enhancing effect of RTB101 [1:57:15];
Concluding thoughts on COVID-19 [1:59:45]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: http://peterattiamd.com/joanmannick-nirbarzilai/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#122 - Lori Gottlieb: Understanding pain, therapeutic breakthroughs, and keys to enduring emotional health Aug 03, 2020

Lori Gottlieb is a psychotherapist and the bestselling author of Maybe You Should Talk to Someone. In this episode, Lori extracts important lessons from her experiences as both a therapist and a patient. The stories Lori shares has provided her the material for insights into living a more fulfilling life. In our conversation, Lori also dispels some misconceptions about therapy, explains the process of big therapeutic breakthroughs, and reveals the most important steps for enduring emotional health.

We discuss:

Lori’s unique path to becoming a therapist [3:00];
Dissecting cadavers—a profound experience during med school [12:30];
The sunk cost fallacy—How Lori was able to walk away from med school [17:15];
Being aware of the gift of life, and other lessons from Lori’s terminally ill patient [24:00];
How underlying pain can manifest in obnoxious behavior [32:45];
Counseling versus therapy [36:15];
The story of John—why men hide their feelings, breaking down his shield, and uncovering his pain [38:30];
“Breaking open”—A shocking revelation about John that tests Lori’s resolve as a therapist [46:30];
Rewriting your story, the recovery process, and the most important step for lasting change [49:00];
The process of many big therapeutic breakthroughs [56:00];
The 2 types of suicidal thoughts, and the importance of talking about it [1:01:00];
The most common issues that bring patients to therapy with Lori [1:02:45];
Clinging to the familiar—why change is so hard [1:05:15];
A story of shame, lack of self-compassion, and self-sabotage [1:07:00];
The importance of managing mental health to reduce unnecessary suffering [1:15:45];
Dispelling the misconceptions about therapy [1:23:15]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/LoriGottlieb Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#121 - Azra Raza, M.D.: Why we're losing the war on cancer Jul 27, 2020

Azra Raza is a physician, scientist, author, and outspoken advocate for reconfiguring the current model of research in cancer. In this episode, Azra discusses the content of her book, The First Cell, which takes a critical look at the outdated models being used to study cancer resulting in a lack of progress in survival rates for cancer patients. Azra offers a solution which focuses on early detection and prevention, and she concludes with an optimistic outlook for the future of cancer research. We discuss:

Azra’s upbringing, interest in oncology, and the basis for writing her book [3:30];
The lack of progress in cancer treatment over the decades [18:45];
What is holding the oncology field back? [33:15];
Do the purported advances in oncology reflect the billions of dollars spent on cancer research? [40:00];
Economics of new cancer drugs—how small increases in survival come with staggering financial burdens [47:00];
How good intentions can still lead to misaligned incentives and a broken system [1:03:00];
Why 95% of new cancer drugs fail—a critical review of the cancer research model [1:11:15];
Early detection and prevention—a potential solution to the cancer problem [1:22:30];
Coping with the loss of her husband to cancer [1:46:00];
Azra’s optimistic view of the future [1:49:30]; and
More.

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#120 - AMA with Dom D’Agostino, Ph.D., Part II of II: Ketosis for cancer and chronic disease, hyperbaric oxygen therapy, and the effect of ketosis on female health Jul 20, 2020

In part 2 of this special AMA episode, ketosis expert Dom D’Agostino once again joins Bob Kaplan, Peter’s Head of Research, to discuss the impact of ketosis on various chronic diseases as well as the latest research on the metabolic management of cancer. Dom also discusses the numerous applications of hyperbaric oxygen therapy, provides insights into the application of ketosis on female health and performance, and much more. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on the website show notes page.

We discuss:

Update on Dom’s Press-pulse therapeutic strategy for the metabolic management of cancer [2:05];
Potential role for vitamin C in cancer treatment [12:45];
Glutamine targeting in cancer therapy—evidence that the mitochondria in cancer are damaged? [17:45];
Can a ketogenic diet lessen the toxicity of cancer therapies? [24:45];
3BP—a promising agent in cancer therapy [26:45];
The relationship between cancer and ketogenic diets [29:30];
Hyperbaric oxygen therapy (HBOT)—primer, protocols, and therapeutic uses [33:30];
Is there a potential role for HBOT in treating COVID-19 patients? [44:15];
Non-cancer applications of HBOT [47:30];
The inverse relationship between glucose and ketones [50:30];
Is a ketogenic diet appropriate for type 1 diabetics? [54:00];
How ketosis may reduce the risk for Alzheimer’s disease and Parkinson’s disease [1:00:30];
Ketosis for females—considerations, fertility, performance, and the latest research [1:11:00];
Low-carb diets during pregnancy and postpartum [1:17:00];
A high-protein diet to counteract common hormonal issues associated with the ketogenic diet [1:21:15];
Nutritional tips for remaining metabolically flexible [1:22:45];
What is one belief Dom has changed his mind about? [1:26:45];
In utero experiments, and other interesting questions Dom wants to explore [1:29:45];
The anti-catabolic effect of ketones, cancer cachexia, and nutritional interventions for cancer patients [1:38:30];
What is the one interesting experiment Dom would do if money and time were not a barrier? [1:46:25]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/domdagostinoama02/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#119 - Terry Real: Breaking the cycle of shame, anger, and depression Jul 13, 2020

Terry Real, a renowned family therapist and best-selling author, helps people create the connections they desire in their relationships. In this episode, Terry describes how his upbringing with an abusive father forged his path to become a therapist, develop his Relational Life Therapy (RLT) framework, and write I Don't Want to Talk About It—a book that reveals the hidden legacy of male depression. Terry discusses the link between childhood trauma and the deep-rooted shame, anger, and depression, which can result in feeling disconnected. Using real-life examples, Terry explains how he implements RLT to confront trauma, discover its origin, and teach the skills to break the cycle of pain, in order to live a satisfying life.

We discuss:

Terry’s upbringing with a depressed and abusive father [3:15];
The importance of the repair process, after relational disharmony, to break the trauma cycle [15:15];
The impact of a patriarchal society, and relational growth as the next step for feminism [19:00];
Origins of deep-rooted shame, and the difference between feeling ashamed and feeling guilty [27:15];
Preventing the propagation of trauma without over-coddling kids [35:30];
The one-up/one-down cycle from grandiosity to shame [37:30];
Covert depression—Steps to fixing the secret legacy of male depression [40:00];
Three forms of false self-esteem [50:00];
Narcissism—A misunderstood concept [51:45];
The interplay of shame, anger, and grandiosity, and how to break the cycle [54:15];
The Relational Life Therapy framework [1:06:30];
How the adaptive child becomes the maladaptive adult [1:15:30];
Speaking the language of social relationships [1:21:45];
When does it make sense for a couple to separate? [1:26:30];
Witness abuse—Consequences of screaming at your partner in the presence of children [1:28:15];
Cases of instantaneous change, and other behavioral changes that may take more time [1:30:45];
Reconciling with his father—Terry’s final conversation with his dad [1:33:45]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/terryreal Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#118 - Lloyd Klickstein, M.D., Ph.D.: Rapamycin, mTOR inhibition, and the biology of aging Jul 06, 2020

Lloyd Klickstein is the Chief Science Officer at resTORbio, a biopharmaceutical company that develops medications to target the biology of aging. In this episode, Lloyd discusses his company’s clinical application of rapamycin and its derivatives. He also elucidates details of his 2014 paper—a paper that greatly influenced Peter’s perspective of rapamycin in the context of longevity. Peter and Lloyd go on to discuss the dose-dependent effect of rapamycin on immune function and compare rapamycin, fasting, and caloric restriction. We discuss:

His background and decision to leave academia for translational medicine [6:15];
Translational medicine—bridging the gap between basic science and clinical medicine [10:30];
What prompted Lloyd to focus on mTOR inhibition? [18:00];
Defining mTOR, TORC1, and TORC2, and the consequences of inhibiting them with rapamycin [21:30];
Dose-dependent impact of rapamycin on immune function, mTOR inhibition, and toxicity [42:15];
Lloyd’s 2014 experiment—mTOR inhibition improves immune function in the elderly [53:00];
Insights into autophagy, antigen presentation, and the pleiotropic benefits of a rapalog, and how it compares to fasting [1:13:00];
Lloyd’s 2018 experiment—TORC1 inhibition enhances immune function and reduces infections in the elderly [1:18:45];
Creation of resTORbio, subsequent studies, and takeaways about dosing, TORC2 inhibition, and tissue selectivity [1:29:00];
Comparing the longevity effect of rapamycin, fasting, and caloric restriction [1:40:00];
Excitement around RTB101—resTORbio’s mTOR inhibiting molecule [1:47:00];
Identifying rapalogs selective for TORC1 [1:56:15];
Treating depression with ketamine, an activator of mTOR [2:00:00];
Epigenetic clocks, rapalogs, and metformin [2:03:30]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/LloydKlickstein Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#117 - Stanley Perlman, M.D., Ph.D.: Insights from a coronavirus expert on COVID-19 Jun 29, 2020

In this episode, Stanley Perlman shares insights from his impressive career studying coronaviruses—both the common and more deadly ones, like MERS and SARS. In comparing preceding coronaviruses with SARS-CoV-2, Stanley discusses how other coronaviruses can aid our current understanding of, and be used to infer about, COVID-19. He also gives his thoughts on durable immunity, therapeutic strategies, and future outbreak preparedness. We discuss:

His background and early work with coronaviruses [2:45];
The coronavirus family—various types, common traits, and scientific understanding [9:00];
The origin of viruses, animal to human transmission, R_0, immunity, and more [17:45];
Insights from the 2002 SARS outbreak [28:30];
Insights from the 2012 MERS outbreak [35:00];
Comparing SARS-CoV-2 to MERS, SARS, and other coronaviruses [42:00];
COVID-19 survivor potential for long-term damage [53:30];
Using the current pandemic for lessons on future preparedness [57:00];
Genetic drift and the potential for long-term immunity to COVID-19 [1:07:00];
Prevention and treatment strategies for COVID-19 and future diseases [1:22:30];
Alternative hypothesis to the origin of SARS-CoV-2 [1:32:30];
Determining durable immunity to COVID-19 and what a successful vaccine looks like [1:34:30]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/stanleyperlman Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#116 - AMA with Dom D’Agostino, Ph.D., Part I of II: Ketogenic diet, exogenous ketones, and exercise Jun 22, 2020

Back by very popular demand for a special AMA episode, ketosis expert Dom D’Agostino joins Bob Kaplan, Peter’s Head of Research, to address many lingering questions about the ketogenic diet, exogenous ketones, and exercise for overall health. Dom also shares valuable insights from his personal experience with training, supplements, intermittent fasting, and other nutritional strategies to optimize his own health and performance. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on the website show notes page.

We discuss:

Dom’s recent and ongoing projects [3:00];
Benefits of a ketogenic diet for an otherwise healthy person [7:00];
Book recommendations to become more knowledgeable about a ketogenic diet [11:30];
Best devices for measuring ketones [13:45];
Genetic factors that influence how someone responds to the ketogenic diet [24:45];
Ketogenic diet for those with the APOE e4 allele [28:15];
Impact of long-term ketogenic diets on thyroid function [34:25];
Low-carb and ketogenic diets for appetite control and weight management [39:00];
Ketogenic diet and the microbiome [43:00];
Comparing monounsaturated fat versus saturated fat on the ketogenic diet [45:55];
Implications of long-term genetic and epigenetic adaptations to a ketogenic diet [47:45];
Why some people see a rise in LDL-C and LDL-P when on a ketogenic diet and what they can do about it [50:15];
Should someone with familial hypercholesterolemia consider a ketogenic diet? [55:00];
Exogenous ketones—benefits, therapeutic uses, and ketone supplements that Dom has tested [56:45];
Ketogenic protocols for management of traumatic brain injuries [1:06:00];
Comparing the benefits and therapeutic uses of various medium-chain fatty acids—caprylic acid (C8), capric acid (C10), MCT oil, and coconut oil [1:08:45];
Nootropics, caffeine, and other stimulants [1:16:15];
Supplemental use of testosterone, DHEA, and creatine for muscle growth and performance [1:23:45];
Impact of fasted-state training on strength and performance [1:30:15];
Stacking exogenous ketones with MCTs for optimal effectiveness [1:33:30];
BCAA supplements during a fast for muscle preservation [1:35:45];
What app is Dom using to track his macros? [1:42:00];
Getting enough micronutrients while on a ketogenic diet [1:47:15];
Ideal macros and getting enough protein for strength training in ketosis [1:48:15];
Pros, cons, and ideal macros of one meal a day [1:51:15];
Dom’s take on “carb backloading” [1:54:45];
Dom’s take on “carb up” days for ketogenic dieters [2:01:00];
Dom’s thoughts on the carnivore diet and the paleolithic ketogenic diet [2:05:30];
Advantages of the ketogenic diet for extreme endurance athletes [2:10:30];
Impact on strength, power, and performance during the adaptation period of the ketogenic diet [2:14:00];
Fasted-state elevation in growth hormone and its impact on training [2:17:45];
Is it possible to build muscle on a ketogenic diet? [2:23:30];
Why Dom took a year off from weight training [2:28:00];
What does Dom do for cardio exercise? [2:30:45];
Protocols for hard training recovery [2:33:15];
Dom’s personal approach to fasting, time-restricted eating, and sleep [2:35:45];
People, books, and other resources that shaped Dom’s training and nutrition [2:38:45]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/domdagostinoama01 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#115 - David Watkins, Ph.D.: A masterclass in immunology, monoclonal antibodies, and vaccine strategies for COVID-19 Jun 15, 2020

In this episode, David Watkins, professor of pathology at George Washington University, shares how insights from his HIV and Zika virus research could apply to SARS-CoV-2 protection strategies. David introduces monoclonal antibodies as an intervention to prevent and treat COVID-19 infection, and also discusses how they could be used as a hedge to vaccine development. Additionally, David’s immunology tutorial explains the innate and adaptive immune systems and their differentiated responses to viral infection.

We discuss:

Background and current interest in immunology [4:30];
Immunology 101—The innate and adaptive immune system [10:15];
Defining antibodies, importance of neutralizing antibodies, and serology testing for COVID-19 [19:00];
B cells—How they fight viruses, create antibodies, and fit into the vaccine strategy [25:00];
T cells—Role in the adaptive immune system and ability to kill infected cells to prevent viral spread [36:15];
Valuable lessons from HIV applied to SARS-CoV-2 [51:00];
Lessons taken from the hepatitis C success story [1:01:30];
Monoclonal antibodies, vaccines, and the most promising strategies for preventing and treating COVID-19 infection [1:04:45];
COVID-19 vaccines in development [1:19:00];
How David’s work with Zika virus informs his thinking on SARS-CoV-2 [1:25:20];
Why a vaccine for COVID-19 doesn’t need to be perfect to be effective [1:27:45]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/davidwatkins Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#114 - Eileen White, Ph.D.: Autophagy, fasting, and promising new cancer therapies Jun 08, 2020

In this episode, Eileen White, Chief Scientific Officer at the Rutgers Cancer Institute, describes the fundamental role of autophagy in the maintenance of health and prevention of neurodegeneration, cancer, and other diseases. She also goes into detail about the paradoxical finding that autophagy may benefit an existing cancer cell and help it to survive—a discovery leading to new possibilities in cancer therapy. We also discuss fasting (and molecules that induce autophagy) and the critical need to decode the proper fasting “dose” in order to improve human health.

We discuss:

Eileen’s discovery that a specific oncogene blocks apoptosis [3:40];
Defining apoptosis and its role in cancer prevention [10:00];
How cancer cells use the autophagy pathway to survive [17:20];
Stressors that induce autophagy [29:15];
The importance of autophagy in the brain and liver [32:45];
The mechanisms that can trigger autophagy to support longevity [40:00];
Evidence for cancer treatment by blocking autophagy [42:30];
Types of cancer that are most autophagy-dependent [46:45];
The autophagy paradox [52:40];
Finding a molecular signal for autophagy [59:15];
Current knowledge gaps around fasting as a tool for longevity [1:13:00];
Rapamycin, metformin, and other molecules that may induce autophagy [1:22:15];
How to study fasting and exercise as longevity tools [1:32:50];
The Nobel Prize for autophagy research [1:36:45];
Eileen’s future areas of research [1:38:25];
A fasting strategy for Alzheimer’s Disease prevention[1:49:25];
Future study of metabolism and autophagy [1:51:30]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/eileenwhite Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#113: Normative errors—a conversation with my daughter about current events Jun 03, 2020

In this episode, I sit down with my daughter to discuss the brutal death of George Floyd, and the aftermath we are watching unfold. Though I have no expertise in race relations, law enforcement, or police brutality, I do have some knowledge in the training of physicians, and it is that training of doctors that I’ve been thinking about lately as it may offer one small insight into this crisis. In this very short discussion, we speak about three types of errors in medicine (and medical training), how to distinguish between the two variants that are acceptable, and the one that is unacceptable. My question, ultimately, is if such a framework can be applied to law enforcement?

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#112 - Ned David, Ph.D.: How cellular senescence influences aging, and what we can do about it Jun 01, 2020

Ned David is the co-founder of Unity Biotechnology, a company developing senolytic medicines—molecules that target and destroy senescent cells in the human body. In this episode, Ned explains the science of cellular senescence and how it impacts the aging process. Ned discusses how senolytics may delay, prevent, treat, or even reverse age-related diseases, including cancer, cardiovascular disease, and neurodegenerative disease. As a serial entrepreneur, Ned also provides advice on how to transform a simple idea into the creation of a company.

We discuss:

Defining longevity and the principles of aging [2:50];
The control knobs of aging and how we can turn them [15:10];
Role of cellular senescence in aging and cancer [27:00];
History of senescence in scientific study [40:30];
The cellular senescence paradox [46:00];
Developing medicines that target cellular senescence [52:15];
Ned’s lessons on risk analysis in business [1:05:15];
The search for a molecule that could eliminate senescent cells [1:15:15];
Senescent cell elimination example in osteoarthritic knees [1:30:30];
Extending lifespan by removing senescent cells [1:45:00];
Senolytic molecule example in macular degeneration reversal [1:52:30];
The future of senescent cell targeting [1:58:30];
The role of cellular senescence and metabolic syndrome [2:01:30];
The role of cellular senescence and brain health [2:03:30]
What prepared Ned to start Unity Biotechnology [2:05:45];
Advice for someone deciding between business and academics [2:08:50]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/neddavid Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#111 - AMA #14: What lab tests can (and cannot) inform us about our overall objective of longevity May 18, 2020

In this “Ask Me Anything” (AMA) episode, Peter explains his framework for understanding what lab tests can (and cannot) inform us as it pertains to overall longevity, with a specific focus on atherosclerosis, cancer, Alzheimer’s disease, and the physical body. Additionally, Peter shares details into two patient case studies around cardiovascular disease, including how the lab results influenced his diagnosis and treatment plan for the patients. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #14 show notes page.

We discuss:

Important lab tests and reference ranges [2:35];
How lab testing fits into the overall objective of longevity [4:25];
A healthcare system set up to react to a disease rather than prevent it [8:00];
The four pillars of chronic disease, and the three components of healthspan [14:30];
Atherosclerosis—How much can labs tell us about risk? [18:00];
Coronary calcium score (CAC)—Interpreting results based on your age [24:15];
Cancer—What lab work can tell you, and the future of liquid biopsies [28:00];
Alzheimer’s disease—What’s driving Alzheimer’s disease, and what labs can tell you about your risk [33:15];
Healthspan and the physical body—Where lab testing fits, the endocrine system, and zone 2 testing [39:00];
Summarizing the usefulness of lab testing—Where it gives great, reasonable, or lousy insight [43:15];
Patient case study—Elevated Lp(a): Understanding ApoB, and how cholesterol levels get reduced [45:30];
Patient case study—Familial hypercholesterolemia [59:30];
Coming up on a future AMA [1:10:30]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama14 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#110 - Lew Cantley, Ph.D.: Cancer metabolism, cancer therapies, and the discovery of PI3K May 11, 2020

In this episode, Lew Cantley, Professor of cancer biology and Director of the Sandra and Edward Meyer Cancer Center at Weill Cornell Medical College in NYC, walks us through his amazing discovery of phosphoinositide 3-kinase (PI3K) and the implications for the care of patients with cancer. He explains various combinations of therapies being tested and used, including the possibility of pairing prescriptive nutritional therapies to increase the efficacy of drugs like PI3K inhibitors. Lew also explains the metabolic nature of cancer through the lens of his research into the connection between sugar consumption, insulin resistance, and tumor growth. Additionally, Lew provides some details about his exciting new clinical trial that is just now enrolling patients with stage 4 breast cancer and endometrial cancer.

We discuss:

Teaching science through the lens of discovery—A better approach to learning science [5:15];
The metabolic nature of cancer, mitochondria, and a more nuanced explanation of the Warburg Effect [8:30];
The observation that convinced Lew to stop eating sugar [20:15];
The connection between obesity, insulin resistance, and cancer [25:30];
Sugar consumption and tumor growth—What did Lew’s 2019 paper find? [32:00];
Natural sugar vs. HFCS, fruit vs. fruit juice, insulin response and cancer growth [43:00];
Increasing efficacy of PI3K inhibitors with ketogenic diets, SGLT2 inhibitors, and metformin [53:30];
Lew’s clinical trial enrolling stage 4 breast cancer and endometrial cancer patients [1:07:30];
Pairing diet with drug could be the future of cancer treatment [1:09:30];
PI3K inhibitors on the market, alpha vs. delta isoform, and the possibility of pairing them with a food prescription [1:16:15];
What questions will Lew be focused on in the next chapter of his career? [1:22:15];
Lew's early work that ultimately led to the discovery of PI3K [1:27:30];
Studying the mechanism by which mitochondria make ATP [1:30:45];
How understanding the mechanism by which insulin drove glucose uptake into a cell got Lew closer to finding PI3K [1:38:15];
How Lew knew PI3K was important in driving the growth of cancer cells [1:55:00];
Lew’s unlikely observation of phosphorylation at the 3' position of the inositol ring resulting in the formation of phosphatidylinositol-3-phosphate [1:59:00]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/lewcantley/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#109 - John Dudley: The beauty in archery, the love of practice, and a model system for life May 04, 2020

In this episode, professional archer, John Dudley, shares the many insights he’s gleaned through the process of not only becoming an elite competitor of archery but also an exceptional teacher. John describes how his desire for improvement has cultivated a sheer love of practice, and how pursuing mastery helped put into context how archery is an amazing model system for life. Additionally, John discusses the often misunderstood nature of hunting, but also makes the case as to why one should consider trying archery even if there is no desire to hunt. We discuss:

Why John loves archery, and what it means to be a professional archer [4:50];
How John’s love of practice and training led to archery [10:45];
How an intense desire to improve drove John to quit football and pursue archery [22:00];
A traumatic childhood event that changed John’s course from troublemaker to committed athlete [34:15];
The nuts and bolts of archery—Competitive events, types of bows, hunting, etc. [45:30];
The blissful nature of archery, and the uselessness of anger [57:15];
Hyper-focus and flow states—Did John’s ADD and task-driven personality give him an advantage? [1:07:15];
The common traits found in the most successful people [1:12:45];
The keys to maintaining credibility as a salesman—Integrity, honesty, and straightforwardness [1:18:45];
The coaching technique that makes John a great teacher [1:28:30];
Why you should consider trying archery (even if you never want to hunt) [1:36:15];
Hunting discussion—The morality argument, hunting vs. commercial farming, managing overpopulation, and the unique emotional connection [1:45:00];
Resources for those interested in taking up archery [2:12:00]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/johndudley Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#108 - AMA #13: 3-day fasting, exogenous ketones, autophagy, and exercise for longevity Apr 21, 2020

In this “Ask Me Anything” (AMA) episode, Peter explains some observations he’s noticed since switching to a 3-day fasting cycle from the longer fasts, the various things he’s measuring, and some helpful tips for getting through a prolonged fast. He also discusses the role of exogenous ketones in fasting and ketogenic diets as well as their impact on autophagy, specifically. Finally, Peter provides some practical advice for those looking to fit exercise for longevity into their busy life. Once again, Bob Kaplan, Peter's head of research, will be asking the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA.

If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #13 show notes page. If you are not a subscriber, you'll be able to listen to a sneak peak of this episode.

We discuss:

Peter’s observations since switching from a 7-day to a 3-day fasting regimen [1:25];
Ketone measuring devices—blood and breath [7:40];
Can zero-calorie sweeteners affect ketone production? [10:40];
Will there be a continuous insulin monitor anytime soon? [11:55];
Exogenous ketones—Role in fasting and ketogenic diets and their effect on insulin, blood glucose, and autophagy [14:10];
5 tips to help you get through a multi-day fast [25:55];
Relationship between BHB levels, glucose levels, and autophagy—Are high levels of ketones enough to produce autophagy? [34:10];
Why is measuring blood insulin so much harder than blood glucose? [36:55];
Advice and resources for people wanting to stay up to date on developments related to health and longevity (and how to quickly sift through all the bad science) [40:10];
Advice for those looking to fit exercise for longevity into their busy life [51:10]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama13 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#107 - John Barry: 1918 Spanish flu pandemic—historical account, parallels to today, and lessons Apr 17, 2020

n this episode, John Barry, historian and author of The Great Influenza: The Story of the Deadliest Pandemic in History, describes what happened with the 1918 Spanish flu pandemic, including where it likely originated, how and why it spread, and what may have accounted for the occurrence of three separate waves of the virus, each with different rates of infection and mortality. While the current coronavirus pandemic pales in comparison to the devastation of the Spanish flu, John highlights a number of parallels that can be drawn and lessons to be learned and applied going forward.

We discuss:

What got John interested in the Spanish flu and led to him writing his book? [2:45];
Historical account of the 1918 Spanish flu—origin, the first wave in the summer of 1918, the death rate, and how it compared to other pandemics [10:30];
Evidence that second wave in the fall of 1918 was a mutation of the same virus, and the immunity immunity protection for those exposed to the first wave [18:00];
What impact did World War I have on the spread and the propagation of a “second wave”? [21:45];
How the government’s response may have impacted the death toll [26:15];
Pathology of the Spanish flu, symptoms, time course, transmissibility, mortality, and how it compares to COVID-19 [29:30];
The deadly second wave—The story of Philadelphia and a government and media in cahoots to downplay the truth [35:50];
What role did social distancing and prior exposure to the first wave play in the differing mortality rates city to city? [44:45];
The importance of being truthful with the public—Is honesty the key to reducing fear and panic to bring a community together and combat the socially-isolating nature of pandemic? [46:15];
Third wave of Spanish flu in the spring of 1919 [51:30];
Global impact of Spanish flu, a high mortality in the younger population, and why India hit so much harder than other countries [55:15];
What happened to the economy and the mental psyche of the public in the years following the pandemic? [59:20];
Comparing the 2009 H1N1 virus to Spanish flu [1:02:10];
Comparing SARS-CoV-2 to the Spanish flu [1:04:20];
What are John’s thoughts on how our government and leaders have handled the current pandemic? [1:08:00];
Sweden’s herd immunity approach, and understanding case mortality rate vs. infection mortality rate [1:10:40];
What are some important lessons that we can apply going forward? [1:13:00];
Does John think we will be better prepared for this in the future? [1:16:00]; and
More

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/johnbarry Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#106 - Amesh Adalja, M.D.: Comparing COVID-19 to past pandemics, preparing for the future, and reasons for optimism Apr 13, 2020

In this episode, infectious disease and pandemic preparedness expert, Amesh Adalja, M.D., puts the current pandemic into context against previous coronaviruses as well as past influenza pandemics. Amesh also provides his interpretation of the evolving metrics which have contributed to big variations in modeling predictions, whether this will be a seasonally recurring virus, and perhaps most importantly—how we can be better prepared for the inevitable future novel virus. Finally, Amesh explains where he sees positive trends which give him reasons for optimism.

We discuss:

Amesh’s background in infectious disease [2:40];
When did the virus actually reach the US? And when did Amesh realize it would pose a real threat to the US? [4:00];
Comparing and contrasting COVID-19 to previous pandemics like the Asian flu of 1958 and the Spanish flu of 1918 [8:00];
Will COVID-19 be a recurring seasonal virus every year? [14:00];
Will a future vaccine be specific to this COVID-19 or will it also cover previous coronaviruses as well? [15:15];
What does Amesh think might be the true case fatality rate of SARS-CoV-2? [16:15];
Why did early models over predict infections and deaths by order of millions? [18:30];
Role of government—How does Amesh view the role of local versus central government in dealing with a future pandemic? [21:50];
What went wrong with testing and how could we have utilized it more effectively? [25:15];
Future pandemic preparedness—why Amesh is cautiously optimistic [27:30];
Should there be different policies and restrictions for places like New York City compared to less populated and less affected places across the US? [30:15];
Why mass gatherings might be disproportionately driving the spread of the virus [32:30];
Learning from HKU1, a lesser-known novel coronavirus from 2005 [34:00];
Thoughts on Sweden’s herd immunity approach [36:10];
The efficacy of masks being worn in public and what role they will play as restrictions are slowly lifted [37:20];
What are some positive trends and signs of optimism? [39:15]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ameshadalja Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#105 - Paul Conti, M.D.: The psychological toll of a pandemic, and the societal problems it has highlighted Apr 10, 2020

In this episode, psychiatrist Paul Conti, M.D. discusses the impact of the fear and uncertainty surrounding the COVID-19 pandemic and the resulting stress, anxiety, and trauma it may impart on the population. Paul examines how this situation has highlighted the challenges we face at the societal level as well as the individual level, and stresses the importance of seeking absolute truth above personal truth and taking action as individuals as a means to combat many of these pervasive problems. We discuss:

Paul’s personal experience with a presumptive case of COVID-19 [2:15];
Through the lens of trauma, Paul’s overall take on the lasting effects of this pandemic on society [4:30];
The imperative to unite as a species given the isolating and suspicious nature of an invisible enemy [8:15];
The indigent population and the affluent population—The commonalities and differences in how both populations have been affected [16:15];
The prevailing feeling of demoralization spanning the population [25:30];
Health care workers—What lingering psychological effects might they suffer from this? [35:00];
Could this pandemic be a catalyst for changing the way people think about science, truth, and logic? [46:30];
How our inability to deal with uncertainty exacerbates the problem, and the need for humility [58:00];
What has been Paul’s recipe for self care during this time? [1:06:45];
The forthcoming challenge of reintegrating back into the world when the quarantines lift [1:14:45];
An urgent need for change which must come through individuals seeking absolute truth and taking action [1:19:15]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/paulconti2 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#104 - COVID-19 for kids with Olivia Attia Apr 08, 2020

In this episode, Peter sits down with his daughter to answer questions from her and other kids about COVID-19.

We discuss:

What is a virus? [1:45];
How did this version of coronavirus (SARS-CoV-2) start? [4:30];
How does COVID-19 compare to SARS and MERS (previous coronaviruses)? [6:00];
Will COVID-19 come back again after we resolve the current issue? [7:15];
When will kids go back to school? [7:45];
How has the US surpassed China in total cases, and how could we have been better prepared for this? [8:30];
Should have we started to quarantine sooner than we actually did? [11:45];
What about herd immunity? Would it be easier if we all just got the virus so we could be immune? [13:45];
Which age groups are the least and most at risk for getting a deadly version of the virus? [15:00];
Why do we have to wipe down packages that are delivered to our homes? [16:30];
How a lack of preparation and discipline led to this troubling situation [18:45];
Is China to blame for all of this? [24:15];
What did Olivia think when her parents pulled her out of school before it was mandated? [26:30];
What's been the hardest part of this for Olivia? [27:50];
What does Olivia appreciate now that she probably didn't appreciate in the past? [28:50];
How are Olivia’s zone 2 workouts going? [30:00]; and
More

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/covid-19-for-kids Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#103 - Looking back on the first 99 episodes: Strong Convictions, Loosely Held Apr 06, 2020

In this episode, originally recorded to be the 100th episode of The Drive, Peter discusses topics that he has changed his mind about since starting the podcast as a result of preparing for interviews as well as from the actual conversations. Peter also reviews some of his favorite moments from the first 99 episodes, shares what books he’s currently reading, and much more. Initially scheduled to be released as episode 100, this was delayed due to recent podcasts covering COVID-19.

We discuss:

Definition of “strong convictions loosely held,” and the value in trying to shoot down your own hypotheses [2:20];
Metformin—How Peter’s strong convictions have changed since 2018 [8:00];
Getting a dog—Why Peter caved and how it’s going so far [15:45];
Rapamycin—How Peter’s feelings have evolved, and the questions still needing to be answered [20:45];
Archery, the joy of pursuing mastery, and the importance of stillness [26:50];
Zone 2 training—Why Peter has made it a big component of his exercise regimen [37:30];
Deadlifts—Why Peter now believes it’s extremely beneficial to longevity when done properly [41:45];
Read any good books lately? [50:00];
Baby aspirin for preventing blood clotting—Why Peter no longer takes it, and a few alternative options [53:15];
Generic drugs—How and why Peter’s mind has shifted on generic drugs [55:45];
Omega-3 fatty acids, EPA and DHA—How Peter’s long-held views have changed [58:15];
How Peter got better at saying “no” [1:02:30];
Does Peter have any favorite episodes of The Drive? [1:07:15]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/strong-convictions-loosely-held Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#102 - Michael Osterholm, Ph.D.: COVID-19—Lessons learned, challenges ahead, and reasons for optimism and concern Mar 31, 2020

In this episode, Michael Osterholm, Director of the Center for Infectious Disease Research and Policy at the University of Minnesota and author of Deadliest Enemy: Our War Against Killer Germs, provides an overview on the COVID-19 pandemic in regards to what has happened to date, what we’ve learned about how the disease spreads, and his optimism and pessimism about what potentially lies ahead. Michael gives his take on the true case fatality rate, why it differs around the world, and which underlying conditions, such as obesity, impact risk of severe illness and death. We also discuss the outlook regarding vaccines, repurposed drugs/antivirals for treatment, and Michael’s growing concern about supply chain limitations with respect to drugs, vaccines, n95 masks, and testing kits. We discuss:

Recapping the brief history of COVID-19 and what potentially lies ahead [2:15];
Some positive news about immunity and reinfection [10:45];
Case fatality rate—The challenge in finding the true rate, difference by country, and the impact of age, underlying conditions, and obesity [13:00];
What has to be true for less than 100,000 Americans to die from COVID-19? [24:30];
How do we best protect healthcare workers? [29:45];
Concerns about testing capability—Reagent shortfall and a supply chain problem [39:30];
Vaccines and antivirals—The outlook, timing, and challenges [47:45];
Long term health of survivors of COVID-19 [56:45];
The impact of comorbidities—Diabetes, obesity, and immunosuppressed patients [59:30];
Understanding R0 and how the disease spreads [1:01:30];
The challenge of forecasting with so many unknown [1:08:00];
What explains the difference in cases and fatalities in different parts of the world? [1:14:30];
Repurposed drugs/antivirals being considered for treatment options—any optimism? [1:16:45];
A parting message from Michael about what lies ahead [1:18:30]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/michaelosterholm Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#101 - Ryan Holiday: Finding stillness amidst chaos Mar 27, 2020

Ryan Holiday, bestselling author and author of Daily Stoic, discusses practical ways to find stillness and apply the insights of stoic philosophy in the midst of COVID-19 chaos. Ryan discusses the importance of taking back a feeling of control, the benefits of structure and routine, and the idea of being prepared for anything. We discuss:

Using times of adversity to evaluate and reflect how you’ve set up and prioritized your life [2:30];
What insights might the famous stoics provide amidst this COVID-19 pandemic? [8:15];
The possible consequences of the socially isolating nature of a pandemic (and why we need good leaders) [13:00];
Stoicism—what it means and how to apply it [18:45];
Lessons taken from the life of Winston Churchill—stillness, structure, routine, hobbies, empathy, forward thinking, and more [23:30];
Alive time vs. dead time—taking control of your time and making it count [38:45];
Auditing how the world (and its leaders) are handling the COVID-19 pandemic through the lens of stoic philosophy [44:15];
Asserting control and using routine to find stillness in an environment not conducive for it [52:15];
Why you should find a way to exercise, especially now [58:30];
How to find purpose during this time—goal setting, having a project to work on, and the benefits of keeping a journal [1:02:00];
What is Ryan most optimistic about and what is he most concerned about over the next few months? [1:08:45];
How can you follow Ryan’s work and messages about stoicism and stillness? [1:17:45].
And more.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ryanholiday2 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#100 - Sam Harris, Ph.D.: COVID-19—Comprehending the crisis and managing our emotions Mar 24, 2020

In this episode, Sam Harris, neuroscientist, author, and host of the Making Sense Podcast, joins Peter to discuss this unprecedented coronavirus (COVID-19) crisis. The discussion includes the important distinction between COVID-19 and influenza, the impact on the economy, the dire situation in New York, and the challenge of creating a safe and effective vaccine. Additionally, Sam brings insights from his extensive meditation practice to help those struggling with stress, anxiety, and fear in this extraordinary situation. We discuss:

A time unlike any other—why many people don’t seem to fully grasp the magnitude of this situation [2:00];
Why comparing COVID-19 to influenza is a bad analogy [10:45]
The impact on the economy of measures like shelter-in-place—Is the “cure” worse than the disease? [16:45];
Why are some places, like New York, getting hit so much worse? [24:45];
The trickle down effect of an overrun healthcare system on non-COVID-19 related health issues [34:45];
How to calm our minds and manage our emotions during this craziness [38:00];
Talking to kids about this situation without burdening them with undue stress [50:15];
Insights from meditation practice—Recognize and unhook yourself from a heightened emotional state [52:00];
How to make the most of a situation where you let your emotions get the best of you [59:15];
What are some potential positive things that Sam hopes could be learned from this crisis and applied to the future? [1:09:30];
The unfortunate politics being layered on top of this crisis [1:15:30];
The challenge of creating a safe and effective vaccine for COVID-19 [1:20:00]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/samharris2 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#99 - Peter Hotez, M.D., Ph.D.: Continuing the conversation on COVID-19 Mar 20, 2020

In this episode, Dr. Peter Hotez M.D., Ph.D., Dean for the National School of Tropical Medicine Baylor College of Medicine, returns to continue the conversation on COVID-19. Dr. Hotez informs us on how we can gauge the number of infected people, behaviors to reduce the probability of becoming infected, and the inconsistency of hospitalizations among young adults between different countries. Dr. Hotez underscores the continued uncertainty in many virus-related developments, but ends with some points of optimism. Disclaimer: This is information accurate as of March 19, 2020, when it was recorded.

We discuss:

- How to gauge true number of infected people [5:45]
- Reducing the probability of getting infected [22:45]
- Inconsistency by country in infected young people [27:15]
- Conferred immunity, seasonality, and repurposed therapeutics [30:30]
- Vaccine development [39:30]
- Practical behaviors to reduce risk of transmission [46:00]
- Mental Health resource and funding [51:00]
- Points of optimism [56:00]; and
- More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/peterhotez-2 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #129 - Evolutionary reasons to sleep Mar 17, 2020

Today's episode of The Qualys is from podcast #47 – Matthew Walker, Ph.D., on sleep – Part I of III: Dangers of poor sleep, Alzheimer’s risk, mental health, memory consolidation, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

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#97 - Peter Hotez, M.D., Ph.D.: COVID-19: transmissibility, vaccines, risk reduction, and treatment Mar 14, 2020

In this episode, Dr. Peter Hotez M.D., Ph.D., Dean for the National School of Tropical Medicine Baylor College of Medicine, shares his expertise on viral disease and how it applies specifically to the coronavirus disease (COVID-19) and the virus that causes it (SARS-CoV-2). Dr. Hotez informs us about the current state of disease progression, which has many unknowns, but has thus far been greatly determined by the delayed response time and lack of testing. Moreover, we discuss what we can do on a country, state, community, and individual level in order to collectively slow transmission of the disease. He shares with us a potential hope in convalescent plasma therapy and underscores the need for US federal involvement - particularly in the creation of a specialty task force to address areas of concern and unknowns.

Disclaimer: This is information accurate as of March 13, 2020, when it was recorded. We discuss:

The disease and the virus: transmissibility and lethality [04:30];
Disease transmission: US playing catch-up [12:00];
Convalescent plasma coronavirus therapy [16:00];
Remdesivir drug treatment and vaccination challenges [19:45];
Disease mechanism and reported pathology [27:45];
Most concerning geographic regions in the US [39:00];
Risk reduction [46:30]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/peterhotez Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #125 - Hierarchies in healthcare, physician burnout, and a broken system Mar 10, 2020

Today's episode of The Qualys is from podcast #37 – Zubin Damania, M.D.: Revolutionizing healthcare one hilariously inspiring video at a time.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

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#96 - David Epstein: How a range of experience leads to better performance in a highly specialized world Mar 09, 2020

In this episode, David Epstein, best-selling author of Range and The Sports Gene, discusses the evidence around the most effective ways to improve long-term performance and learning in our specialties, our sports, our careers, and our lives. David makes a compelling case that a range of experiences and skills are more likely to lead to expert performance compared to early specialization, and offers an in-depth critique of the much-publicized 10,000-Hour Rule. David also provides insights into our role as parents in the process of encouraging exposure to many things, the concepts of when to push them, when to give them space, and when to allow them to quit. Furthermore, David goes into many other fascinating topics such as the role of talent, genetics, and practice in reaching expert status, what differentiates a kind vs. wicked learning environment, the importance of “informal training,” and many case studies that suggest strategies for short-term success may not be best for long-term development.

We discuss:

A shared interest in Ayrton Senna, and pondering the value in participating in sports [2:30];
Examining the 10,000-Hour Rule, and the importance of questioning existing dogma [15:00];
How the medical profession is affected by bad science, and the importance of understanding individual variation [28:00];
David’s most surprising findings when writing The Sports Gene [35:45];
Kind versus wicked learning environments [40:45];
How and why strategies for short-term success may not be best for long-term development [47:30];
Contrasting the success stories of Tiger Woods and Roger Federer—which path is more common, and an argument for diversified training and experiences [59:15];
Is there an age-range or “critical window” during which exposure is necessary to reach a certain level of proficiency or mastery of a skill or knowledge? [1:14:00];
How diversifying your interests and unraveling your identity from your speciality could lead to more enjoyment and actually improve performance in your speciality [1:22:15];
The undervalued importance of “informal training” [1:29:15];
Advice for increasing match quality in your work—where interests and abilities align—to optimize both job performance and fulfillment [1:41:15];
Would David want his own son to attend college given the current state of higher education? [1:51:15];
The role of a parent—how to encourage sampling, when to push them, when to allow them to quit, and insights from the childhoods of Tiger Woods and Wolfgang Mozart [1:55:45];
The need for varied perspectives and the ability to improvise—insights gained from the Space Shuttle Challenger tragedy [2:08:45];
How a diversified background and identity could be the difference in life or death—the Hotshot firefighters case study [2:22:15];
David’s takeaways from the inspiring story of Frances Hesselbein [2:29:00]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/davidepstein Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #121 - The “art” of longevity: the challenge of preventative medicine and understanding risk Mar 03, 2020

Today's episode of The Qualys is from podcast #52 – Ethan Weiss, M.D.: A masterclass in cardiovascular disease and growth hormone – two topics that are surprising interrelated.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

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#95 - Luke Bennett, M.D.: The emotional, cognitive, and physical demands that make Formula 1 a unique and special sport Mar 02, 2020

In this episode, Luke Bennett, Medical and Sports Performance Director for Hintsa Performance, explains the ins and outs of Formula 1 with a focus on the behind-the-scenes human element, and what makes it so emotionally, cognitively, and physically demanding for the drivers as well as the many team members. Luke first talks about his fascinating background with the Royal Flying Doctor Service in Australia, which lead to his current position with Hintsa working closely with F1 drivers to improve their health and performance despite jet-lag and sleep constraints due to an unrivaled travel schedule. Luke also sheds light on the underappreciated level of sheer physical strength and endurance it takes to drive an F1 car combined with the extreme cognitive aptitude, spatial awareness, and ability to navigate a socially complex environment that is needed to be successful as a driver. Additionally, Luke gives an overview of how the F1 season and races work, the incredible advances in car technology and safety measures, and what Luke and Hintsa hope to bring in the near future to the unique and special sport that is Formula 1.

We discuss:

What it’s like to be a “flying doctor” in Australia, and how Luke ended up working in Formula 1 with Hintsa [3:10];
Behind the scenes of Formula 1—crazy travel, jet lag, massive teams, and fascinating human storylines [10:45];
The incredible physical strength and cognitive aptitude needed to be a F1 driver [19:00];
The technological leap to hybrid electric engines [29:30];
The trend towards younger drivers in F1 [32:30];
Advancements in safety—the history and recent upgrades [36:00];
How Hintsa manages the athletes through the incredible social complexity of the sport [41:45];
Explaining the difference between F1, F2, F3, and F4, and the path to reaching the F1 [47:30];
Comparing F1 in the 60s & 70s to today—Incidences of deaths, number of crashes, physicality of driving, new regulations, and more [53:45];
Women in F1—Past, present, and future [1:06:10];
How F1 teams manage their cars and engine over the season, & some new regulations coming in 2021 [1:09:15];
What insights has Luke taken from his time as a triathlete to working with F1 drivers? [1:12:50];
How Luke survived cancer, and gained an increased sense of empathy [1:15:45];
How Luke manages his health against the brutal travel and lifestyle that comes with working in Formula 1 [1:19:40];
New training techniques, technology to monitor the physiology of drivers, and other things Luke is hoping to bring to Formula 1 [1:22:40];
How long does it take a driver to learn a new circuit? [1:27:45];
The incredible emotional control needed to be a successful F1 driver [1:30:00];
Which F1 teams are showing signs of competing in future seasons? [1:32:15]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/lukebennett Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #120 - What is the difference between ketone salts and esters? Feb 28, 2020

Today's episode of The Qualys is from podcast #05 – Dom D’Agostino, Ph.D.: ketosis, n=1, exogenous ketones, HBOT, seizures, and cancer.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

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#94 - Mark Hyman, M.D.: The impact of the food system on our health and the environment Feb 24, 2020

In this episode, Mark Hyman, M.D., director of the Cleveland Clinic Center for Functional Medicine and the author of Food Fix, discusses that if we can fix the food system, we can solve many big problems—namely the chronic disease/obesity epidemic, the rising costs of healthcare, as well as the big problems facing the environment. Mark first briefly lays out the health consequences of processed food with a focus on the gut microbiome. From there, Mark discusses the environmental consequences of industrial farming and lays out how we can affect change on the individual level, through policy and regulations, and perhaps most importantly through regenerative agriculture. Additionally, Mark talks about the potential health risks of consuming GMO foods, herbicides, and other chemicals used in industrial farming as well as the environmental consequences, such as the loss of soil, caused by those same fertilizers and methods of farming.

We discuss:

The negative consequences of the existing food environment [3:25];
What makes processed food so unhealthy? [9:00];
The gut microbiome: Inflammation from gut permeability and how to measure gut health [18:30];
Steps to fixing a bad gut—The Five R’s [24:30];
Some staggering health statistics, and which races might be more genetically susceptible [27:15];
An argument for government regulations and policies to fight back against a massive food industry with unlimited resources (and what we can learn from the tobacco story) [29:00];
Industrial farming and climate change: The degradation of soil and use of fertilizer [41:45];
Regenerative agriculture: Could it be the answer to food waste, our health problems, and the environment? [51:45];
Comparing the Impossible Burger to regeneratively raised beef [1:06:00];
GMO and Roundup—The potential health risks of consuming GMO foods sprayed with Roundup (glyphosate) and other herbicides and pesticides [1:08:15];
How the livelihood of farmers are being affected by big ag companies and the current industrial farming system [1:16:30];
The loss of biodiversity in our food, and what “organic” really means [1:19:00];
What can people do on the individual level to protect themselves as well as affect change to the toxic food system? [1:25:00];
What role does the USDA play in this “toxic” food environment and how do we fix it? [1:30:15];
The top 3 changes Mark would make if he was “food czar” [1:35:15];
Mark’s rebuttal against the argument that it’s best for the environment if we stop farming animals and move to a fully plant-based diet (and his argument for “agriculture 2.0") [1:36:30];
What is Mark’s overall mission with the work that he’s doing? [1:40:30];
Bread in the US vs. Europe: Why does bread (and wheat products) taste different and potentially cause less health problems in Europe versus the US? [1:42:00]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/markhyman Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #116 - Dealing with anger in spots where you know it’s coming Feb 21, 2020

Today's episode of The Qualys is from podcast #34 – Sam Harris, Ph.D.: The transformative power of mindfulness.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

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#93 - AMA with Jason Fried: Work-life balance, avoiding burnout, defining success, company culture, and more Feb 17, 2020

In my first interview with Jason Fried, Jason explained his overall philosophy about work-life balance and how exactly he optimizes for efficiency. For this special follow-up AMA, we've decided to release the full episode to everyone (including non-subscribers), so all can hear Jason answer questions from listeners that dive deeper into topics such as work-life balance, the role of luck versus hard work in success, specifics around Basecamp’s unique process-oriented approach to projects, 4-day work weeks, practical tips for people searching for the right company culture, tips on writing and parenting, and a whole bunch more.

If Jason had taken his own advice about work-life balance at the start of his career, would he have achieved the same level of success? [2:05];
What is Jason’s definition of success, and what is he optimizing for? [10:10];
Basecamp’s policy on email and expectations for a quick response, and why Jason believes in sleeping on big decisions [14:30];
How Jason implements “true” work-life balance in his life and at Basecamp [19:15];
Does work and life have to be separated in order to have balance? [32:00];
How Jason makes time the fixed component to avoid the compulsion to keep pushing forward on a project perpetually [34:15];
Jason’s tip for physicians who may be facing burnout [45:00];
Signs of “burnout” if you do the same thing for work and pleasure, and tips to avoid and manage that feeling [49:45];
Is a 40-hour work week the correct amount? [53:45];
How to evaluate a company’s culture when looking for a job with the right work environment [59:00];
Jason’s take on salaries and alternate incentives like equity, profit sharing, etc. [1:06:45];
What traits does Jason look for when hiring new employees? [1:13:45];
Does Jason believe in process-oriented work or outcome-driven work, and Basecamp’s unique process for completing projects [1:16:15];
How does Jason handle a project that results in a failure? [1:20:00];
Advice for people in situations where they don’t have full control of their time and work demands [1:23:50];
How much of success should be attributed to skill versus luck? [1:29:30];
The importance of writing skills, and tip to improve your writing [1:43:15];
Lessons learned from parenting, and Peter’s top priority when it comes to raising kids [1:52:15];
An important skill: the ability to say “no” to things [2:01:15]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/jasonfriedama Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #109 - How does one select the right physician as a patient? Feb 11, 2020

Today's episode of The Qualys is from podcast #04 – AMA #1: alcohol, best lab tests, wearables, finding the right doc, racing, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

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92 - AMA #12: Strategies for longevity (which don't require a doctor) Feb 10, 2020

In this “Ask Me Anything” (AMA) episode, Peter explains the various levers one can pull to affect longevity with a specific focus on the strategies and tactics one can implement that do not require the help of a physician. Once again, Bob Kaplan, Peter's head of research, will be asking the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #12 show notes page.

We discuss:

The five levers you can pull to affect longevity [1:15];
Nutritional biochemistry: Framework, 3 nutritional interventions, and how to approach your goals, and what you should be tracking [4:30];
Exercise for brain health, and the 4 components of exercise [20:45];
Exercise component—Stability [24:30];
Exercise component—Strength [29:00];
What is Peter optimizing for with his exercise? [30:30];
Exercise components—Zone 2 and zone 5 training [33:15];
More about DNS, and why we need to be careful with rushing kids through neuromuscular development stages [45:00];
Sleep: How to improve quantity and quality [48:15]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/AMA12 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #106 - Does LDL cause heart disease? Feb 05, 2020

Today's episode of The Qualys is from podcast #03 – Ron Krauss, M.D.: a deep dive into heart disease.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#91 – Eric Topol, M.D.: Can AI empower physicians and revolutionize patient care? Feb 03, 2020

In this episode, Dr. Eric Topol, founder and director of the Scripps Research Translational Institute, shares how artificial intelligence and deep learning is currently impacting medicine and how it could transform the healthcare industry, not only in terms of the technological advancements, but also in restoring the patient-doctor relationship for better patient outcomes and experiences. We also discuss Eric’s rich and fascinating career in cardiology as well as his involvement as one of the first outspoken researchers to question the cardiovascular safety of Vioxx.

We discuss:

Eric’s background and his source of interest in cardiology [3:15];
The US medical field’s resistance to technological change and learning from other healthcare models [11:15];
Eric’s mission at the Cleveland Clinic [20:15];
How Eric helped to elucidate the issues with Vioxx (and why he came to regret it) [29:45];
How Eric came to found one of the most influential research centers in the world [47:30];
How AI and deep learning is currently impacting medicine, and the future possibilities [56:30];
Gut microbiome—Its role in health, impact on glycemic response and fuel partitioning, and how deep learning could improve our research and treatment [1:17:45];
Why machines combined with human doctors is superior to one without the other [1:32:00];
How AI and machines can reinstate medicine as an attractive career (and alleviate physician burnout) [1:36:45];
Eric’s dream experiment [1:47:15] and;
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/erictopol Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #102 - Is the food industry still saying that all calories contribute equally to adiposity and insulin resistance? Jan 29, 2020

Today's episode of The Qualys is from podcast #14 – Robert Lustig, M.D., M.S.L.: fructose, processed food, NAFLD, and changing the food system.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#90 - Ryan Holiday: Stillness, stoicism, and suffering less Jan 27, 2020

In this episode, Ryan Holiday, author of Stillness is the Key, shares the profound impact that stoic philosophy has had on his personal life and his career as a successful writer. Ryan stresses the importance of stillness in a modern world set up to encourage the opposite and lays out the best strategies to develop stillness in your life. He also explains the destructive nature of being driven by ego, as well as the perils of jealousy and anger, and provides practical steps you can take to avoid those harmful states.

We discuss:

Has a more connected world improved or worsened our lives? [2:15];
Consequences of an overly secure life, living in the present, & the misconception of unlimited time [5:45];
Stoicism 101: The definition and origins of stoic philosophy [15:45];
Ryan’s career transition into writing, and his take on what makes a book or business successful [26:45];
Storytelling—The upside and downside of telling stories and self-narrative [36:15];
Does achieving success have to come from a place of craving and proving others wrong? And what are the costs of building a legacy? [38:45];
Ego—confusing ego with confidence, signs your ego is showing, & antidotes to the negative effects of ego [52:45];
Ryan’s advice to Peter about writing (and finishing) his book [1:06:30];
Stillness—what it is, how it compares to meditation, & the obstacles to achieving stillness [1:10:30];
Ryan’s morning routine, relationship with his smartphone, and how he avoids falling victim to the trappings of technology and a hyperconnected world [1:17:40];
The perils of jealousy and envy [1:24:15];
How to live in the moment in a modern world not designed for stillness [1:32:15];
How the idea of “dying well” can help you live better [1:36:00];
How has fatherhood impacted Ryan’s philosophies on stillness and living in the moment? [1:39:45];
How to make your favorite day your every day [1:42:00];
The most reliable strategies for developing stillness [1:47:30];
Anger—what the stoics say about anger, outrage in politics, & why more anger isn’t the solution [2:02:00];
How to follow Ryan’s work [2:12:00]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ryanholiday Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #99 - The steroid controversy: Mark’s use of them and Peter’s perspective Jan 23, 2020

Today's episode of The Qualys is from podcast #28 – Mark and Chris Bell: steroids, powerlifting, addiction, diet, training, helping others, documentaries, and living your best life.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#89 - AMA #11: All things fasting Jan 20, 2020

In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of fasting-specific questions from subscribers. Peter starts by defining the various fasting protocols, details his own personal fasting regimen, explains his revised plan for 2020, and provides a ton of value to anyone interested in fasting. Once again, Bob Kaplan, Peter's head of research, will be asking the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #11 show notes page. We discuss:

Defining the various fasting protocols [1:00];
Why Peter plans to switch to a 3-day fast once per month in 2020 [11:00];
How Peter uses his CGM to gain insights into the depth of fast [13:15];
Peter’s supplement protocol during fasting, and why he eats a ketogenic diet leading up to a prolonged fast [17:00];
Peter’s exercise regimen during a fast [23:30];
Peter’s hunger levels during a typical 7-day fast [26:45];
Fasting observations—Core body temperature and thyroid hormone [30:30];
Fasting observations—Glucose, BHB, and hunger levels [33:15];
Peter’s sleep protocol during a fast [40:15];
Does Peter observe any differences between men and women in their ability to fast? [47:00];
How Peter prefers to break a long fast [50:15];
Importance of community support while fasting, and is there a perfect fasting protocol? [52:00]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama11/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #94 - Comparing the two broad types of meditation, and Peter’s favorite meditation apps Jan 15, 2020

Today's episode of The Qualys is from podcast #34 – Sam Harris, Ph.D.: The transformative power of mindfulness.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

Qualy #89 - Cortisol and healthy aging Jan 07, 2020

Today's episode of The Qualys is from podcast #31 – Navdeep Chandel, Ph.D.: metabolism, mitochondria, and metformin in health and disease.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#87 - Rick Johnson, M.D.: Fructose—The common link in high blood pressure, insulin resistance, T2D, & obesity? Jan 06, 2020

In this episode, Rick Johnson, Professor of Nephrology at the University of Colorado, explains how his research into the causes of blood pressure resulted in a change of research direction to focus more on how fructose has such profound metabolic effects. Rick discusses the relationship between salt and high blood pressure, provides a masterclass into uric acid, and expertly reveals the mechanisms and pathways by which sugar (specifically fructose) can profoundly impact metabolic health. From there, he explains how he applies this information to real life patients, as well as touches on some of the most promising ideas around pharmacotherapy that are being developed in response to the epidemics of fatty liver, insulin resistance, diabetes, and obesity. Furthermore, Rick gives his take on artificial sweeteners compared to real sugar, discusses cancer’s affinity for fructose, and much more.

We discuss:

The connection between blood pressure and fructose that shifted Rick’s professional focus [4:00];
The relationship between salt and blood pressure (and the role of sugar) [5:45];
Defining fructose, glucose, and sugar [19:30];
An ancient mutation in apes that explains why humans turn fructose into fat so easily [23:00];
The problems with elevated uric acid levels, and what it tells us about how sugar causes disease [31:30];
How sugar causes obesity—explaining the difference in glucose vs. fructose metabolism and the critical pathway induced by fructose [40:00];
Why drinking sugar is worse than eating it [50:00];
Unique ability of sugar to drive oxidative stress to the mitochondria, insulin resistance, and diabetes [54:00];
Why cancer loves fructose [1:00:15];
The many areas of the body that can use fructose [1:05:00];
Fructokinase inhibitors—a potential blockbuster? [1:07:15];
Treating high uric acid levels—Rick’s approach with patients [1:10:00];
Salt intake—what advice does Rick give his patients? [1:16:30];
How excess glucose (i.e., high carb diets) can cause problems even in the absence of fructose [1:21:00];
Artificial sweeteners vs. real sugar—which is better? [1:29:15];
Umami, MSG, alcohol, beer—do these have a role in metabolic illness? [1:33:45];
Fructose consumption—Is any amount acceptable? Is fruit okay? Where does Rick draw a hard line? [1:38:45]
How does Rick manage the sugar intake of his young kids? [1:43:00]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/rickjohnson Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #85 - The past, present, and future of medicine, hospitals, and healthcare Dec 31, 2019

Today's episode of The Qualys is from podcast #06 – D.A. Wallach: music, medicine, longevity, and disruptive technologies.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

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#86 - Damon Hill: Overcoming loss, achieving success, and finding one's identity Dec 30, 2019

In this episode, Damon Hill, 1996 Formula 1 World Champion, opens up about his personal struggles with depression, feelings of inadequacy, loss of identity, and his ultimate path to healing following his remarkable racing career. Damon’s life was given a tragic jolt at 15 years of age when his father and legendary F1 driver Graham Hill died suddenly—the common string that ties together so much of his life and has forged so much of who he is to this day. We discuss Damon’s unique and remarkable racing career including his legendary battles with Michael Schumacher as well as Damon's firsthand account of what happened that tragic day on May 1st, 1994, when his teammate, Ayrton Senna, died at Imola. But this is not just about racing; rather it’s a human story that's cloaked in a racing one.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/damonhill/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #82 - What is the most common first presentation of heart disease? Dec 25, 2019

Today's episode of The Qualys is from podcast #03 – Ron Krauss, M.D.: a deep dive into heart disease.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#85 - Iñigo San Millán, Ph.D.: Mitochondria, exercise, and metabolic health Dec 23, 2019

In this episode, Dr. Iñigo San Millán, Assistant Professor at the University of Colorado School of Medicine, explains the crucial role of mitochondrial function in everything from metabolic health to elite exercise performance. Iñigo provides a masterclass into the many different energy system pathways, the various fuel sources (including the misunderstood lactate), the six zones of exercise training, and the parameters he uses to measure metabolic health. Additionally, he highlights the power of zone 2 training in its ability to act as a powerful diagnostic tool, and perhaps more importantly as a treatment for mitochondrial and metabolic dysfunction.

We discuss:

Iñigo’s background in sports and decision to focus on education [7:15];
Explaining the various energy systems and fuels used during exercise [14:45];
Iñigo qualifies energy systems into six training zones [26:00];
Lactate is an important fuel source [33:00];
Zone 2 training—physiologic characteristics, fuel sources, lactate, and the transition into zone 3 [40:30];
Using blood lactate levels (and zone-2 threshold) to assess mitochondrial function [47:00];
Accessing mitochondrial function by looking at one’s ability to utilize fat as fuel (with an RQ test) [55:00];
Athletes vs. metabolically ill patients—mitochondria, fat oxidation, muscle glycogen capacity, “fat droplets”, and more [1:00:00];
Physiologic characteristics of zone 3, zone 4, and the lactate threshold [1:20:00];
Fueling exercise—dietary implications on glycolytic function [1:30:30];
Relationship between exercise and insulin sensitivity (and what we can learn from studying patients with type 1 diabetes) [1:46:30];
Metformin’s impact on mitochondrial function, lactate production, and how this affects the benefits of exercise [2:04:15];
Raising awareness for risk of “double diabetes” [2:15:00];
How to dose zone 2 training, and balancing exercise with nutrition [2:18:00];
Proposed explanation of the Warburg Effect: Role of lactate in carcinogenesis [2:27:00];
Doping in cycling, and the trend towards altitude training [2:39:15] and;
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/inigosanmillan Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #80 - The four pillars of charity: water that helped it overcome the stigma of nonprofits and become successful Dec 20, 2019

Today's episode of The Qualys is from podcast #25 – Scott Harrison: transformation, finding meaning, and taking on the global water crisis.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#84 - AMA #10: Low testosterone, hypothyroidism, building muscle (and preserving it while fasting) Dec 16, 2019

In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter’s head of research, asks the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed. You can also listen to this full episode on our website at the AMA #10 show notes page. We discuss:

Does testosterone supplementation impact longevity? [2:40];
Under what conditions does Peter decide to treat patients who have low testosterone? [8:50];
Are there risks involved with testosterone replacement therapy? [17:10];
How does Peter diagnose and treat hypothyroidism? [21:30];
How might someone do time-restricted feeding while also adding muscle mass? [26:30];
If building muscle requires higher levels of IGF-1, should we be concerned about longevity? [34:45];
How to preserve muscle mass while fasting [41:45];
Is it possible to simultaneously lose fat and add muscle mass? [46:30]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama10 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #73 - How can we change the food system when 10 companies control almost 90 percent of the calories we consume in the US? Dec 10, 2019

Today's episode of The Qualys is from podcast #14 – Robert Lustig, M.D., M.S.L.: fructose, processed food, NAFLD, and changing the food system.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#83 - Bill Harris, Ph.D.: Omega-3 fatty acids Dec 09, 2019

In this episode, Bill Harris, Ph.D. in human nutrition and expert on omega-3 fatty acids, sets the table by clearly defining the families of fatty acids (saturated, monounsaturated, polyunsaturated) before diving into the current landscape of polyunsaturated fat (omega-6 and omega-3) with a particular focus on EPA and DHA (the two main elements of fish oil supplements). Bill gives a historical overview, updates us on the latest science related to the health benefits, and provides plenty of insights as to how we should think about increasing our EPA and DHA intake.

We discuss:

Bill’s long history of studying fatty acids [6:30];
Defining the fatty acids—SFA, MUFA, PUFA, omega-3, omega-6, and more [9:45];
What is the significance of fatty acids? Why should we care? [19:45];
History of fat phobia, saturated fat, and does PUFA reduce cholesterol? [23:45];
Breaking down the conversion process of omega-6 and omega-3 fatty acids including how we get to EPA and DHA [28:00];
Takeaway from Bill’s 1980 study looking at how salmon oil affected cholesterol and triglyceride levels [36:15];
History of our understanding of omega-3 and its effect on LDL cholesterol [45:00];
Prescribed fish oil drugs vs. OTC supplements—Differences and recommended brands [52:00];
Health benefits of EPA [57:45];
Potential benefits of ALA and how it compares to taking EPA and DHA directly [1:12:45];
Health benefits of DHA [1:17:15];
Cell membrane omega-3 index—What is it, the role of genetics, how to increase it, and a recommended target [1:19:00];
Is EPA or DHA neuroprotective? Can it help with depression? [1:23:30];
Recommended fish to eat for EPA and DHA - Any mercury concerns? [1:25:45];
Can omega-3 mitigate risks associated with smoking? [1:29:15];
The problem with the omega-6 to omega-3 ratio [1:30:00];
The problem with labeling any kind of fatty acid as “bad” [1:36:00];
Why increasing EPA and DHA intake matters more than reducing omega-6 intake [1:38:00];
Important takeaway from the VITAL study [1:46:30];
Importance of testing your omega-3 index [1:53:00];
Exciting study coming out soon, and why you need to take your fish oil with food [1:57:15]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/billharris Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #69 - Advice to parents and kids for creating a sustainable environment that’s going to prevent them from running into metabolic problems Dec 03, 2019

Today's episode of The Qualys is from podcast #14 – Robert Lustig, M.D., M.S.L.: fructose, processed food, NAFLD, and changing the food system.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#82 - Mark Messier: Leadership, personal growth, and performing under pressure Dec 02, 2019

In this episode, Mark Messier, six-time Stanley Cup champion, shares the most valuable lessons he picked up over 25+ years of professional hockey resulting in one of the longest and most decorated careers in hockey history. Mark shares what lead to his unique brand of humble leadership, how he was able to get talented individuals to effectively work as a team, the importance of maturing and evolving as a person, and how he was able to stay calm and perform at his best under enormous amounts of pressure. Additionally, we go through his favorite moments as a player, what it was like playing with and learning from The Great One, Wayne Gretzky, and much more.

We discuss:

Overview of Mark’s extraordinary 25+ year professional hockey career [7:15];
The trend towards kids focusing on one sport earlier and earlier—A good or bad thing? [12:00];
Mark’s early passion for hockey, and when he realized it could be his “job” [14:15];
Going pro at age 17 [19:30];
Mark’s favorite experience playing professional hockey [25:45];
Playing with (and learning from) the great Wayne Gretzky [26:40];
A hard lesson learned in his first year as a pro [32:00];
Lessons learned from losing his first Stanley Cup Finals [35:45];
Redemption—Winning his first Stanley Cup and the beginning of a dynasty in Edmonton [41:15];
Importance of team character [54:00];
The shocking trade of Wayne Gretzky, and Mark stepping up as the new leader and team captain [59:30];
Playing for the New York Rangers—the lure of the city and the pressure to perform [1:07:00];
Ending the 54-year championship drought for the New York Rangers [1:13:30];
Becoming a great leader [1:16:30];
How to win the mental war against your opponent [1:20:30];
Opposing players for which Mark had great respect [1:22:00];
Retiring after an unbelievably long and lustrous career [1:27:00];
How to leverage stress and nervousness into a positive force [1:32:45];
The most important quality—A willingness to learn, improve, and evolve [1:36:00];
What does Mark do today for exercise to stay in great shape? [1:44:30];
Why playing sports is such a great thing for kids [1:49:30];
The Mark Messier Foundation [1:53:00];
How has Mark avoided the “loss of identity” feeling which plagues many retired athletes? [1:56:15];
Does Mark think it’s possible to reproduce a team as good as his Oilers teams of the 80s? [1:59:30];
Would Mark ever want to coach in the NHL? [2:03:00];
Will the Toronto Maple Leafs ever win the Stanley cup? [2:04:00]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/markmessier Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #65 - The three laws of medicine — Law #1: A strong intuition is much more powerful than a weak test Nov 26, 2019

Today's episode of The Qualys is from podcast #32 – Siddhartha Mukherjee, M.D., Ph.D.: new frontiers in cancer therapy, medicine, and the writing process.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#81 - Debra Kimless, M.D. & Steve Goldner, J.D.: Cannabis – the latest science on CBD & THC Nov 25, 2019

In this episode, Dr. Debra Kimless and Steve Goldner share their knowledge on the science, policy, and market evolution of medicinal cannabis. We start with the differences between THC and CBD, how they work in the body, and how they act on the brain. We discuss the many potential benefits of using CBD, THC, hemp in the various forms of administration (smoking, vaping, edibles, oils, etc.) as well as some of the safety issues including the recent uptick in incidents of hospitalization and death linked to vaping. Debra and Steve are both involved with the company, Pure Green—Debra the Chief Medical Officer and Steve the founder and CEO—whose aim is to create the safest, most efficacious form of delivery of cannabis. Their bigger mission is to shift the perception of the cannabis plant, garner acceptance of its medicinal benefits, and ultimately get it descheduled on a federal level so more people can access cannabis for a range of chronic ailments.

We discuss:

Debra and Steve’s background reason for their interest in medical cannabis [7:00];
The history of medical use of cannabis [11:15];
How THC, CBD, and other cannabinoids work [16:00];
Hemp—What it is, special uses, and the 2018 farm bill [22:45];
The legal status of CBD, Deb and Steve’s clinical trial, and how CBD differs from THC [30:15];
The safety profile of THC [35:00];
Is marijuana as a gateway drug? [45:30];
Smoking vs. vaping vs. edibles—Benefits, risks, and mechanistic differences [53:30];
Can you build up a tolerance to the effects of THC? [1:15:00];
What do people generally want to get from using marijuana? [1:17:15];
Cannabinoid synthetics [1:22:30];
Efficacy of CBD oils as a sleep aid [1:25:00];
Pure Green Cannabis [1:30:30];
Anecdotal evidence and managing the hype surrounding cannabis in medical treatment [1:38:45];
Aspirations for the future of medicinal cannabis, and the legal challenges that await them [1:45:15];
Descheduling cannabis: A human rights issue [2:04:00] and;
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/debrakimless-stevegoldner/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #61 - Rapamycin in cancer treatment Nov 19, 2019

Today's episode of The Qualys is from podcast #10 – Matt Kaeberlein, Ph.D.: rapamycin and dogs — man’s best friends? — living longer, healthier lives and turning back the clock on aging and age-related diseases.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#80 - Celebrity AMA #1: Fasting, rapamycin, performance vs. longevity, and more Nov 18, 2019

In this special, bonus celebrity AMA episode, Peter answers questions from former Olympians and past guests, Apolo Ohno and Sasha Cohen, on a wide range of subjects including fasting, learning, training for performance versus longevity, and much more. This bonus AMA is available in full to everyone.

Apolo's questions begin [1:45];
Why women may have a harder time fasting, and tips for those who are struggling [2:10];
Is there any place for fasting as part of a nutritional strategy in adolescents? [6:15];
Tips for learning and retaining large amounts of new information (and the best nutritional approach) [9:15];
Must read books of 2019 [14:45;
If you could only keep a few watches for the rest of your life which would they be? [16:45];
What workout would Peter do inside a hotel room? [22:15];
What is Peter’s ultimate gorge meal? [23:45];
How do you foresee fasting as a mechanism for performance in athletes? [25:30];
What is driving Peter to strive for excellence? [33:30];
Sasha's questions begin [38:40];
What are you most excited about in the longevity space? [38:45];
At what point do you see enough data or proof that a new drug, or type of fasting is worth trying it out for yourself? [41:30];
Is it possible to obsess so much about your health that it becomes a negative stressor? [46:45];
Which tests are worth doing if you want to be proactive about your health? [48:15];
Are there any supplements Peter things are beneficial to be taking? [55:15];
How does Peter’s training differ when optimizing for performance versus longevity? [56:30];
How does taking testosterone and growth hormone affect performance versus longevity? [59:15]; and
More.

Learn more: https://peterattiamd.com/

Show notes page for this episode:https://peterattiamd.com/celebrityama01 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #57 - A primer on NAD+/NADH, its effect on lifespan/healthspan, and a review of the supplements Nov 12, 2019

Today's episode of The Qualys is from podcast #02 – Rhonda Patrick, Ph.D.: the performance and longevity paradox of IGF-1, ketogenic diets and genetics, the health benefits of sauna, NAD+, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#79 - Ric Elias: Earning the gift of life Nov 11, 2019

In this episode, Ric Elias, founder of Red Ventures, opens up about the fateful day he knew for certain that he was going to die as a passenger on US Airways Flight 1549. Ric dives deep into how that day impacted his life, greatly changed his perspective, and improved his relationship with his family and the broader community. We also talk about his incredible role as CEO of an enormous company, his remarkable work in philanthropy, and all the wisdom he has acquired in his extraordinary life. We discuss:

Ric’s life leading up to the day of the plane crash [5:30];
The plane crash—What it’s like knowing you’re about to die, feelings of regret and sadness [11:15];
The improbable plane landing in the Hudson River [19:00];
Emotions after the safe landing (and a story he’s never told before) [25:45];
A powerful story about Captain Sully [29:30];
Earning his second chance at life, and playing the “infinite game” [38:30];
Why time is the ultimate currency, and how (and why) to say “no” [46:15];
Raising kids in an achievement culture, Ric’s definition of life success, and what Ric wants to instill in his kids [53:00];
What Ric believes is actually worth getting upset, and the organizations that are taking steps to help people [1:09:00];
The core principles of Red Ventures (Ric’s company) [1:19:15];
Ric’s tips for developing business acumen and negotiation skills [1:29:30];
What qualities does Ric look for in people he wants to work with? [1:32:50];
What is the next big problem that Ric wants to solve? [1:35:30];
What is the most challenging part of your business today? [1:37:30];
If Ric could go back and talk to himself in the morning before getting on that plane, what would he say? [1:39:15]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ricelias Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #53 - Screening for prostate cancer Nov 05, 2019

Today's episode of The Qualys is from podcast #39 – Ted Schaeffer, M.D., Ph.D.: How to catch, treat, and survive prostate cancer.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#78 - Sasha Cohen: The price of achievement, and redefining success Nov 04, 2019

In this episode, Sasha Cohen, former US Olympic figure skater, discusses the most challenging things about life as an Olympian—the pressures, the expectations, years of sacrifice, but worst of all a loss of identity post-career resulting in many former Olympians suffering from depression. We begin by talking about everything that led up to her unforgettable moment from the 2006 Olympics, and how she handled herself so beautifully in the face of disaster. Most importantly, we talk about post-skating life when she shares many insights such as the downside of constantly striving for a moment, the hollowness of achievement, and the importance of redefining our definition of success.

We discuss:

Sasha’s mindset going into the 2006 Olympics as the favorite [6:30];
Figure skating basics, scoring, short program vs. long program, etc. [13:40];
Sasha’s unforgettable performance at the 2006 Olympics [18:10];
Win, lose, or draw, why many Olympians suffer from a loss of identity [32:30];
Dealing with the disappointment of “losing the gold” [40:30];
The tiny window of opportunity for Olympians, and the overwhelming pressure to meet expectations [49:30];
Sasha’s unique childhood, finding figure skating, and channeling her hyperactive personality into becoming an amazing skater [1:01:30];
The consequences of extreme training at a young age, and trying to control the uncontrollable [1:10:00];
What is driving extreme athletes and Olympians to be the best? [1:18:30];
Why many former Olympians and athletes struggle with depression [1:25:00];
Refining success—How Sasha overcame her own loss of identity [1:32:30];
What advice would Sasha give her 15-year-old self? [1:40:45];
Lessons we can learn from watching the rapid downfall of many former Olympians [1:45:00];
Advice for people who are tying their identity to being “successful” or striving to be “the best” [1:56:00];
Life lessons Sasha wants to apply to being a mother to her baby boy she is expecting [2:05:00]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode:https://peterattiamd.com/sashacohen Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #52 - Insights about berberine Nov 01, 2019

Today's episode of The Qualys is from podcast #26 – AMA #3: supplements, women’s health, patient care, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#77 – AMA #2 with sleep expert, Matthew Walker, Ph.D.: short sleep mutants, optimal sleep environment, sleep apnea, & rapid fire questions Oct 28, 2019

In this special episode, Matthew Walker returns for his second AMA episode where he provides his expert insight on numerous sleep-related questions directly from listeners. He answers a wide range of questions from the gene that causes the short sleeping phenotype, to the ideal sleeping position, to the optimal temperature for best sleep, to how fasting affects sleep, plus a full dissertation on sleep apnea, and much, much more. We discuss:

DEC2—A genetic mutation that produces a short sleeping phenotype [11:00];
What is the best position to sleep in? [22:45];
Should you consider a “sleep divorce” with your partner? [27:00];
The challenge of kids wanting to sleep in bed with their parents [28:45];
Is there an ideal type of pillow? [32:30];
Any data on hammock sleeping? Should adults be rocked to sleep like a baby? [34:45];
The optimal room temperature and body temperature for the best sleep [38:30];
Do humidifiers help? [50:40];
How do high altitudes affect sleep? [53:15];
What is the data on weighted blankets (e.g., the Gravity blanket)? [57:00];
Caffeine—How much, and in what way, does it affect sleep? [58:15];
How does sexual activity relate to sleep quality? [1:04:00];
Should we be sleeping in two phases? First sleep & second sleep? [1:06:30];
Napping—Is there ideal duration? Should we be napping or not? [1:08:30];
Advice for new parents dealing with sleep deprivation [1:12:00];
Understanding your sleep chronotype [1:16:15];
If you drink too much alcohol in a given night, is there anything you can do to make sure your sleep isn’t wrecked? [1:20:45];
How postmenopausal women can manage their sleep problems with (and without) hormone replacement therapy [1:23:00];
Could a daily practice of Wim Hof's breathing method help or hinder quality of sleep? [1:29:15];
Why do some people paradoxically feel more tired the more they sleep? [1:31:15];
Sleep apnea—How to know if you have it, the different types, the causes, and helpful resources [1:33:15];
Is there such a thing called “sleep eating”? [1:45:00];
If Matt was “sleep czar”, what changes would he make to society to improve sleep? [1:46:15];
Catch up sleep: Explaining the difference between retrospective damage and prospective benefit [1:48:45];
Does poor sleep really speed up the aging process? [1:50:30];
Is medicated sleep better than no sleep? [1:53:00];
Does vivid dreaming disrupt the sleep cycle? [1:56:45];
Is there potential benefit to using “binaural beats” or some type of sound to induce better sleep? [1:57:45];
How is sleep affected by fasting and time-restricted eating? [1:59:45];
Is there any evidence that polyphasic sleep (e.g., "Uberman") works? [2:03:30]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: peterattiamd.com/matthewwalkerama2/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #46 - Rapamycin’s effects on cancer, cardiovascular disease, and neurodegeneration Oct 23, 2019

Today's episode of The Qualys is from podcast #09 – David Sabatini, M.D., Ph.D.: rapamycin and the discovery of mTOR — the nexus of aging and longevity?.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#76 - Kyle Kingsbury: Finding meaning, depression, and psychedelics Oct 21, 2019

In this episode, Kyle Kingsbury, retired UFC fighter and director of human optimization at Onnit, discusses the purpose and meaning that football and MMA gave him but which also acted as a distraction from his inner demons. Kyle opens up about his use of PEDs (steroids, testosterone, HGH) in college and talks about some of the misconceptions around them. Next, Kyle talks about his battle with depression and a close call with suicide that lead to life-changing experiences with psilocybin and ayahuasca—which really became the turning point in his own journey towards being more emotionally healthy, finding inner peace, and being a better husband and father. *DISCLAIMER: The substances spoken about in this episode are illegal and by no means are we advocating for anyone to use them or experiment with them. There are physical, physiological, psychological, and legal risks around the use of these plants. This conversation is purely informational only.

We discuss:

Growing up in a volatile home [6:30];
Playing college football at ASU, and letting go of NFL aspirations [15:45];
Kyle’s experience taking anabolics (steroids/testosterone), misunderstood science, and fear mongering [23:15];
Kyle’s experience with taking HGH [35:30];
The Whizzinator [36:45];
Struggles with depression and drugs, and a lack of meaning after football [41:00];
Kyle’s close call with suicide, and a spiritual experience [47:15];
Finding refuge with mixed martial arts, and Kyle’s early success in cage fighting [52:30];
Lessons from Kyle’s first loss in fighting, and training for the UFC [59:45];
First experiences with psilocybin and ayahuasca, quieting the monkey mind, and finding inner peace [1:07:15];
Overt vs. covert depression, depression in men vs. women, and the transition from adaptive to maladaptive behaviors [1:16:00];
Peeling back the layers with ayahuasca: Kyle tells stories about the most transformative experiences with psychedelics [1:19:00];
Does Kyle feel like he has lost his “edge” as a result of his journey? [1:26:15];
Where would Kyle be had he not discovered the power of psychedelic medicines? [1:29:45];
Parenting: Stopping the cycle of trauma, reconnecting to our ancestral roots, and Kyle’s opinion on ayahuasca as a potential tool for kids [1:31:40];
Relationship with parents, blind spots, compassion, and forgiveness [1:37:15]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode:peterattiamd.com/kylekingsbury/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #43 - What are Peter’s thoughts on fasting and ketosis for females? Oct 17, 2019

Today's episode of The Qualys is from podcast #26 – AMA #3: supplements, women’s health, patient care, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#75 - David Light: Zantac recall due to cancer concerns – what you need to know Oct 14, 2019

In this episode, David Light, CEO of Valisure (the company which alerted the FDA to the Zantac cancer concerns), explains the story behind the recent recalls by manufacturers of ranitidine, a common heartburn medication, sold under the trade name Zantac, due to a potential link to increased cancer risk. David breaks down all the evidence, the role of his unique pharmacy company which tests all its drugs before being dispensed to consumers, and the reason behind the FDA’s tempered reaction to the alarming study results. David makes the argument that Zantac/ranitidine is an inherently unstable molecule which explains the grossly excessive amounts of NDMA (a probable human carcinogen) as opposed to just a contamination for which there could be numerous causes. Finally, David and Peter both provide recommendations for what to do if you or someone you know is currently taking Zantac/ranitidine.

We discuss:

The impetus for starting Valisure, a unique online pharmacy that tests all its medications [6:45];
The story behind the recall of valsartan, and the role which Valisure played [24:30];
Testing Zantac: The shocking results from Valisure’s initial testing with major potential cancer implications [36:00];
NDMA - the probable human carcinogen found in Zantac/ranitidine [48:45];
The epidemiology question: Are we inferring too much from epidemiology? What can we take away from the existing studies? [53:30];
The staggering results from the 2016 Stanford study, why it didn’t alarm more people, and how Valisure found the missing biological link [1:01:30];
Alerting the FDA, the FDA’s tempered response, and question of contamination vs. inherent instability [1:07:30];
How confident is David that the elevated levels of NDMA being found in ranitidine are not due to instrumentation, human error, or temperature contamination? [1:24:15];
The massive risk being taken by the FDA by not doing more to keep ranitidine away from consumers [1:25:15];
If someone is taking Zantac/ranitidine, what should they do? What else do they need to know? [1:27:45]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/davidlight/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #38 - Finding meaning in struggle and why we are less happy than ever (David Foster Wallace) Oct 09, 2019

Today's episode of The Qualys is from podcast #15 – Paul Conti, M.D.: trauma, suicide, community, and self-compassion.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#74 – Jason Fried: Optimizing efficiency and work-life balance Oct 07, 2019

In this episode, Jason Fried, co-founder of Basecamp, shares his beliefs around achieving business success in a modern world which tends to disproportionately focus on the massive success stories (the outliers). Jason gives his honest take on companies like WeWork, Uber, and Lyft that may give off the appearance of wild success but may instead provide an example of the dangers of perverse incentives. We get into Jason’s backstory, and how his affinity for optimizing efficiency and production in the workplace culminated with the creation of Basecamp, his very successful web-based project management software business. Perhaps most importantly, we get really deep into all aspects of work-life balance and what it really means to “work hard” (Stay tuned for an AMA-style deep dive into the topic of work-life balance with Jason in the near future). In addition, Jason provides many more valuable nuggets including thoughts on some common mistakes made by businesses today, the value of giving employees autonomy, how to take the right types of risks, why he doesn’t set any goals, and much, much more.

We discuss:

Jason’s background and his early entrepreneurial spirit [9:45];
Views on completing higher education and the notion of hard work [24:00];
Beliefs around success in business [35:00];
WeWork, Uber, and Lyft: Poor business practices and the dangers of perverse incentives [41:30];
Jason’s early career: his redesign approach and personal motivation [56:00];
The genesis of Basecamp [1:10:00];
Why Jason does not set goals but instead focuses on a vision [1:12:15];
Workplace motivation and hiring practice [1:20:30];
The importance of luck and not overworking [1:32:00];
A framework to work less and optimize for workplace autonomy [1:38:00];
The importance of saying ‘no’ more often (and tips for doing so) [1:55:00];
A shared passion for watches [2:03:30];
Guarding against the perils of phone addiction [2:08:45];
Jason’s views on email and chat for communication [2:15:00] and;
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode:peterattiamd.com/jasonfried Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #33 - How silent bravado and incessant striving can lead to a functional (and actual) death, and why Paul is critical of the current state of psychiatry Oct 01, 2019

Today's episode of The Qualys is from podcast #15 – Paul Conti, M.D.: trauma, suicide, community, and self-compassion.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#73 - AMA #9: NAD & metformin, fat-burning zone, creatine, estrogenization of men, emergency kit for cold & flu, and more Sep 30, 2019

In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter’s head of research, asks the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed. You can also watch (or listen) to this full episode on our website at the AMA #9 show notes page. Questions continue to be pulled from the AMA section on the website, and any subscriber is welcome to submit questions for future AMAs. We discuss:

The story of how Peter almost worked for Theranos [2:00];
The trend of lower testosterone and higher estrogen in men: Why is it happening and what to do about it? [10:00];
Takeaways from Peter’s recent hunting trip in Hawaii [14:45];
What books are you currently reading/listening to? [21:30];
What advice would you give to the 25 year-old Peter? [24:00];
What is your emergency protocol if you start getting sick? [27:45];
How have your thoughts changed on NAD precursors, and also on metformin, in the past year or so? [30:30];
What are your thoughts on “fat burning” zones for cardio workouts? — A lesson in relative vs. absolute fat combustion [34:15];
What mental models do you use and how do you go about solving problems and approaching difficult questions? [49:00];
Creatine supplementation—Yay or nay? Why? [49:30]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama09/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#72 - Dan Harris: 10% happier – meditation, kindness, and compassion Sep 23, 2019

In this episode, Dan Harris, correspondent for ABC News and co-founder of the Ten Percent Happier meditation app, speaks openly about his struggles with self-centeredness, addiction, depression, emotional volatility, and the deep-rooted insecurities that drove him to career success. He tells the story of how a panic attack on live TV lead him down a path of self-discovery culminating in a meditation practice which has since transformed his life—in terms of his own personal suffering, his relationships with those closest to him, and his ability to be kind and compassionate (which has its own selfish advantages). Dan also shares some very practical advice and tips for new meditators, dispels some of the myths around meditation, and gives people some things to look forward to as they progress with their practice. Last but not least, we talk about the importance of not passing shame and trauma to our kids and the role that mindfulness and meditation plays in that.

Dan’s meditation book, and the panic attack on live TV that started it all [8:00];
Addiction: the spectrum of addiction, the socially acceptable forms, and Dan’s own battle with addiction and depression [13:30];
Dan’s drive for self-protection, a defining moment of childhood, and how his upbringing shaped him [20:30];
A selfish reason to be kind and compassionate [28:30];
Using mindfulness to avoid being controlled by your emotions such as anger and grandiosity [36:15];
How Dan found meditation, and how he went from skeptic to someone willing to try it [40:45];
Advice for new meditators, misconceptions about meditation, and the difference between changes in state vs. changes in trait [48:00];
Difference between being “mindful” versus being “present” [55:00];
The overlap between psychology and Buddhism, who is the real Buddha, and a Buddhism 101 lesson [57:45];
What convinced Dan to finally try meditation, and how did his first session go? [1:05:30];
Lessons from Dan’s 10-day silent retreat: “You’re trying too hard” [1:12:30];
How Dan’s meditation has evolved over 10 years of practice [1:27:30];
Dan’s 360 Review: A painful process illuminating his selfishness, and putting him on a path to more kindness and compassion [1:30:45];
How to quiet mental suffering in tough times, and how meditation has helped (and not helped) Dan get through some of the hardest moments of his life [1:41:30];
How Dan’s practice has made him a better husband [1:47:45];
How to prevent the transference of trauma and shame to your kids [1:50:45];
Does past trauma drive successful people? Can a person be successful professionally if they give up that negative insecurity that is driving them? [1:56:00];
The pillars of emotional health, and how to help yourself when you feel insecure [2:08:30];
Why it’s important to let your kids see that you are a flawed human [2:11:30];
Learning from the incredible (but flawed) Peter Jennings [2:15:15];
When is Dan’s next book coming out? [2:21:15]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/danharris/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #26 - What is Peter looking to achieve and monitor with his blood glucose monitor? Sep 18, 2019

Today's episode of The Qualys is from podcast #26 – AMA #3: supplements, women’s health, patient care, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#71 - Katherine Eban: Widespread fraud in the generic drug industry Sep 16, 2019

In this episode, Katherine Eban, investigative journalist and author of Bottle of Lies, illuminates the prevalence of fraud in generic drug manufacturing which brings into question the idea that generics are identical to brand-name drug as we are lead to believe. Katherine walks us through how this widespread corruption came to be, including the shocking story of one particularly egregious (and unfortunately not uncommon) example of an Indian drug company, Ranbaxy, whose business model was completely dependent on falsifying data in their drug applications to the FDA. We then discuss the subsequent investigation into Indian and Chinese drug manufacturing plants which revealed that nearly 80% of them are tainted with fraud. We conclude this discussion on a positive note with i) how individuals can investigate their own drugs to protect themselves ii) an innovative pharmacy attempting to disrupt the market and iii) some ideas on how to reform to the regulations around generic drugs, the FDA, and more.

We discuss:

How Peter found Katherine’s book, and what convinced her to investigate the generic drug industry [5:45];
Branded vs. generic drugs: Why they aren’t the same thing [11:15];
The Food and Drug Administration: Why it was originally created and what it does today [20:45];
How the generic drug industry really got its start in the U.S., and the flaw of the Hatch-Waxman Act [28:20];
PEPFAR: How a well-intentioned plan to help Africa with the AIDS epidemic laid the groundwork for corruption [36:30];
The story of Ranbaxy: An Indian drug company whose business model was fraud and deceit [40:45];
How the FDA approves drugs, the impact of “first to file”, and Peter’s tangent on moral corruption [47:30];
A booming generic drug market and the FDA struggling to keep up [57:15];
Dinesh’s internal investigation finds widespread fraud and falsified data inside Ranbaxy [1:00:15];
Presenting the famous SAR document to Ranbaxy’s board of directors which spells out the company-wide fraud [1:09:15];
Dinesh blows the whistle on Ranbaxy which leads to a raid on their US plant [1:19:45];
Formal investigation of Ranbaxy is launched, but the FDA keeps approving Ranbaxy drug applications [1:33:30];
What role does the culture in India play in the high prevalence of fraud in the drug industry? [1:41:00];
The extreme prevalence of data fraud/manipulation in foreign generic drug factories [1:52:30];
Concluding the Ranbaxy story [2:06:15];
How concerned should you be when buying a generic drug from your local pharmacy? [2:11:15];
How to investigate your own drugs for quality to ensure you are getting what you need [2:18:30];
An innovative pharmacy that tests all its drugs for quality [2:24:45];
Reforming the FDA and generic drug industry: Why we need reform and ideas on how to do it [2:27:45];
The importance of taking individual ownership and not waiting for Congress to bail us out [2:34:00];
Closing thoughts from Katherine [2:36:50]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode:

https://peterattiamd.com/katherineeban/

Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #24 - What are the “ABCs” of Alzheimer’s prevention? Sep 13, 2019

Today's episode of The Qualys is from podcast #18 – Richard Isaacson, M.D.: Alzheimer’s prevention.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#70 - David Sinclair, Ph.D.: How cellular reprogramming could slow our aging clock (and the latest research on NAD) Sep 09, 2019

In this episode, David Sinclair, Ph.D., a Professor in the Department of Genetics at Harvard Medical School and co-Director of the Paul F. Glenn Center for the Biological Mechanisms of Aging, returns to the podcast to discuss the content of his new book, Lifespan: Why We Age - and Why We Don’t Have To. This conversation focuses on the biological mechanisms involved in what David terms the Information Theory of Aging which provides insights into the “clock” that determines our aging and to what degree it can be manipulated. Our discussion on aging of course leads us into interconnected topics of epigenetics, sirtuins, cellular senescence, as well as what compounds David is personally taking for his own longevity. Additionally, we discuss the most up to date information related to NAD and longevity by looking at the potential benefits (if any) of supplemental agents (NAD precursors, NR, NMR, etc.) that pose a promise of increasing NAD.

We discuss:

SIR genes and cellular identity [8:45];
Sirtuins regulate gene expression [14:30];
DNA is methylated at the deepest layer of the epigenome [17:45];
Methylation pattern and determining cellular age [20:15];
Cellular reprogramming [33:45];
Yamanaka factors to push cells "back in time” [41:00];
Human cellular reprogramming viability [57:00];
Measuring the rate of aging [1:02:45];
Cellular reprogramming for longevity [1:14:45];
Compounds David takes for his own longevity [1:29:15]
NAD precursors (NR, NMN) and pterostilbene [1:40:00];
The current field of sirtuin activators [2:03:15];
David’s artistic work [2:05:15] and;
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode:https://peterattiamd.com/davidsinclair2/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #19 - A unifying theory of aging Sep 05, 2019

Today's episode of The Qualys is from podcast #27 – David Sinclair, Ph.D.: Slowing aging – sirtuins, NAD, and the epigenetics of aging.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#69 - Ronesh Sinha, M.D.: Insights into the manifestation of metabolic disease in a patient population predisposed to metabolic syndrome, and what it teaches us more broadly Sep 02, 2019

In this episode, Dr. Ronesh Sinha, a physician, author, and educator based in Silicon Valley, shares his many insights into metabolic illness that he has gleaned from his South Asian patient population. In this conversation we focus on hyperinsulinemia, insulin resistance, metabolic dysregulation, inflammation, blood pressure, obesity, etc. and ways to address them with nutrition, sleep, exercise, stress management, and more. We also take a deep dive into insulin resistant phenotypes, evolutionary theory and geographic determinants of insulin resistance which provides insight into the genetic architecture and pathophysiology of metabolic syndrome. Additionally, we discuss the surprisingly interrelated topic of stress, and how we might be inadvertently passing this on to our children, leading to mental and physical sickness down the road.

We discuss:

How a stubborn case of insulin resistance connected Peter with Ronesh [7:15];
Ronesh’s clinical treatment focus of metabolic illnesses in South and East Asian patient populations [8:45];
The distinction between visceral fat and subcutaneous fat stores [15:00];
Shortcomings of a body mass index (BMI) calculator for evaluating metabolic disease risk [17:15];
Cortisol and blood glucose variability [28:30];
Insulin’s role in elevated blood glucose: A symptom of metabolic syndrome [33:25];
Mechanistic explanations of insulin resistance (there may be more than one) [35:15];
Theories on origins and evolutionary reasons for insulin resistance [40:00];
The inverse relationship between the amount of brown adipose tissue and rates of insulin resistance, and the role of climate in patterns and prevalence of insulin resistance [49:50];
Vitamin D levels, hyperinsulinemia, and other effects [53:45];
The evolutionary benefit of being able to turn fructose into fat (and the price we are now paying for it) [58:00];
The VO2 max relationship to insulin resistance and familial metabolic health [59:30];
Using zone 2 fitness test to evaluate mitochondrial performance [1:01:15];
Exercise for long-term functional health [1:06:00];
Lifestyle changes to improve insulin resistance and other metabolic phenotypes [1:14:00];
Is PCOS a manifestation of insulin resistance? [1:21:00];
The impact of stress on adiposity, and Peter’s treatment regimen for overweight females resistant to typical nutritional approaches [1:23:45];
How a culture of achievement and expectations can lead to undue stress, unhappiness, and health problems in our children (a Silicon Valley case study) [1:35:00];
The negative impact of devices and social media on children [1:48:45];
How you can help yourself, your family, and your community without being an MD or PhD [1:55:00]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode:https://peterattiamd.com/roneshsinha/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #16 - How much does cognitive activity ward off cognitive decline? Aug 30, 2019

Today's episode of The Qualys is from podcast #18 – Richard Isaacson, M.D.: Alzheimer’s prevention.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#68 - Marty Makary, M.D.: The US healthcare system—why it’s broken, steps to fix it, and how to protect yourself Aug 26, 2019

In this episode, Marty Makary, Johns Hopkins surgeon and NYT bestselling author, discusses his ambitious attempt to fix the broken U.S. healthcare system through educating the public, changing the lexicon, encouraging radical transparency in pricing, and more. We go in detail into the main drivers of inflated health care costs, the money games being played making it hard to understand, and the unfortunate system structure that has resulted in one in five Americans finding themselves in medical debt collections which can ruin the lives of people and families seeking basic medical care. Marty also shares some very practical advice and tips if you find yourself a victim of predatory pricing and stuck with an outrageous medical bill. In the end, despite the current state of the system, Marty discusses the many exciting trends gaining traction in healthcare and why he is very optimistic and hopeful about the future.

We discuss:

The science of delivering healthcare, how we need to do better as a system, and why no single person or entity fully to blame [10:15];
The stories that prompted Marty to write his first book (Unaccountable) [19:15];
The Surgery Checklist [26:15];
The problem is with the system (not any one person or entity) and the misaligned interests of all the parties involved [28:15];
Patients crave honesty and transparency, and the story of Peter’s back surgery gone wrong [33:00];
Today’s med students and young doctors have less tolerance for predatory pricing and healthcare industry BS [44:30];
Funny stories about John Cameron (legendary surgeon at Johns Hopkins) [48:00];
How doctors are trained to internalize traumatic experiences which can result in a misunderstood form of “burnout” [57:40];
The beat down of med students with traditional medical education and some exciting innovations to medical education [1:07:00];
Exciting trends in healthcare and an optimistic view of the future [1:11:30];
The Price We Pay (Marty’s new book), an attempt to illuminate the blackbox that is the US healthcare system [1:21:00];
Why it’s not always in the best interest of the insurance company to negotiate the best price [1:28:30];
Who is actually paying for medical costs, and Marty’s frustration with the healthcare lexicon [1:32:00];
Pros and cons of a single payer system [1:37:00];
How to fight outrageous medical bills and predatory pricing (and make a dent in the wasteful healthcare spending for the country) [1:49:30];
Disrupting the healthcare industry with private healthcare facilities with market demanded transparency [2:05:45];
The people hurt the worst by the current US healthcare system, the sad breast cancer statistic, and the importance of knowing that medical bills are negotiable [2:09:30];
The healthcare industry bubble [2:14:00];
Increased costs from unnecessary tests and procedures [2:16:30];
Malpractice concerns due to the litigious culture in America: What influence does it have on unnecessary testing, healthcare costs, and overall quality of treatment [2:22:00];
Drug pricing, price gouging, middle-men money games, kickbacks, and other drivers of healthcare costs [2:27:45];
How can we possibly fix the healthcare system? [2:34:30];
Helpful resources [2:46:15]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode:https://peterattiamd.com/martymakary/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #9 - The importance of exercise for brain health Aug 20, 2019

Today's episode of The Qualys is from podcast #02 – Rhonda Patrick, Ph.D.: the performance and longevity paradox of IGF-1, ketogenic diets and genetics, the health benefits of sauna, NAD+, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

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#67 - AMA #8: DNA tests, longevity genes, metformin, fasting markers, salt, inflammation, and more Aug 19, 2019

In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter’s head of research, asks the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed. You can also watch (or listen) to this full episode on our website at the AMA #8 show notes page. Questions continue to be pulled from the AMA section on the website, and any subscriber is welcome to submit questions for future AMAs. We discuss:

Do DNA kits provide actionable info for cancer, CVD, diabetes, Alzheimer’s, nutrition, or exercise? [1:45];
What genes increase longevity? And do those genes show up on genetic tests like 23andMe? [12:00];
Who are some people that Peter would like to have as guests on The Drive? [15:00];
Inflammation: Is CRP a useful marker? What can one do to reduce it? And what other inflammatory markers can I look at to gauge health? [18:30];
What lipid test does Peter now use on his patients? What are the three best cardiovascular laboratories? [28:00];
Metformin for longevity: What considerations should one think about before doing taking metformin for longevity purposes? [32:30];
What is Peter’s take on salt and its role in things like high blood pressure and stomach cancer? [40:00];
What markers does Peter find most interesting (and surprising) during his quarterly fasts? [47:30]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode:http://peterattiamd.com/ama08 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #6 - What are the best lab tests to request specifically for longevity Aug 14, 2019

Today's episode of The Qualys is from podcast #04 – AMA #1: alcohol, best lab tests, wearables, finding the right doc, racing, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

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#66 - Vamsi Mootha, M.D.: Aging, type 2 diabetes, cancer, Alzheimer’s disease, and Parkinson’s disease – do all roads lead to mitochondria? Aug 12, 2019

In this episode, Dr. Vamsi Mootha, an expert in mitochondrial biology and investigator at the Howard Hughes Medical Institute, shares his breadth of knowledge on the mitochondrion organelle: its history, function, genome architecture, and his research of rare mitochondrial dysfunction. Vamsi is currently focused on finding clinical treatments for the 300-some identified rare disorders, but in this work there is a wealth of potential implications in the context of longevity and chronic disease. In this conversation, Vamsi elucidates how the latest research could give insight into conditions related to aging, including but not limited to Alzheimer’s disease, Parkinson’s disease, insulin resistance and type 2 diabetes, cancer, and much more. We also explore some of the most exciting potential therapies for mitochondrial diseases such as hypoxia (oxygen deprivation), how exercise affects the mitochondria, the use of hyperbaric chambers for cancer therapy, and the mechanisms by which Metformin might confer longevity benefits in a non-diabetic individual.

We discuss:

The Broad Institute of MIT and Harvard [8:00];
Vamsi’s academic background [10:30];
Advice for college students and med students considering a career in medicine and/or medical research [15:30];
Vamsi’s focus on mitochondria and mitochondrial disorders [20:00];
The mitochondrial genome: Lineage, endosymbiosis, and reductive evolution [23:15];
How many diseases can be attributed to mitochondrial mutations? [28:45];
Nuclear DNA and mtDNA: Roles, interaction, communication, and biogenesis [31:30];
Which cells have the most mitochondrial DNA? And how often does mitochondria turn-over in a cell? [37:30];
Does ALL of your mitochondrial DNA come from your mother? [40:00];
Mitochondria 101: The powerhouse of the cell, electron transport chain, and the NADH/NAD ratio [44:00];
NAD and NADH: Role in the mitochondria, decline of NAD levels with age, and what it means to age at a mitochondrial level [51:30];
Mitochondrial diseases Vamsi studies in his lab [55:15];
Mitochondria and oxygen: Poor oxygen utilization and excess oxygen contributes to the pathology seen in some of the rare mitogenic diseases [1:02:00];
What VO2 max can tell us about mitochondrial function, insulin resistance, type 2 diabetes, and more [1:10:00];
Can studying mitochondrial disease provide insights into the common forms of aging? [1:18:45];
Could muscle cell inflammation (a signature of aging) be caused by mtDNA damage being confused as foreign bacteria? [1:22:00];
Exercise and mitochondrial health: Is there an optimal exercise strategy to slow the aging process? [1:27:00];
What autophagy means in the context of mitochondria [1:36:15];
Metformin’s impact on exercise and lactate levels [1:40:15];
How might metformin confer longevity benefits? [1:48:15];
Hypoxia as a potential therapeutic option for mitochondrial disease [1:52:45];
Cancer prevention and treatment: hyperbaric oxygen chambers, targeting single carbon metabolism of the mitochondria, and more [2:00:00];
Chronic diseases have altered mitochondria: Evidence for mitochondrial dysfunction causing Parkinson’s disease [2:04:30];
Why Vamsi is very optimistic about the possibility of targeting mitochondrial proteins as therapies [2:09:30];
Is it theoretically possible to genetically engineer a better functioning mitochondria? [2:14:30];
Vamsi’s fantasy experiment in an unconstrained world [2:20:15]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/vamsimootha/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #1 - What are Peter's thoughts on alcohol consumption and health? Aug 06, 2019

Today's episode of The Qualys is from podcast #04 – AMA #1: alcohol, best lab tests, wearables, finding the right doc, racing, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#65 - Rick Doblin, Ph.D.: MDMA— the creation, scheduling, toxicity, therapeutic use, and changing public opinion of what is possibly the single most important synthetic molecule ever created by our species Aug 05, 2019

In this episode, Rick Doblin, founder and executive director of MAPS, discusses MDMA, a molecule that has (at a minimum) revolutionary therapeutic benefits for PTSD, but arguably could have, at the highest order, a lasting impact on humanity’s ability to peacefully coexist. Rick details the history of MDMA, what lead to its unfortunate criminalization, and his lifelong work trying to protect MDMA (and other psychedelics) from criminalization (and his subsequent attempt to decriminalize it). Through his founding of MAPS, Rick has made enormous progress in debunking many of the exaggerated risks being claimed against MDMA (neurotoxicity, memory loss, depression, Parkinson’s, etc.), and is very close to getting FDA approval for a psychotherapy technique using MDMA. Additionally, in this discussion, you will learn about the history of LSD, psilocybin, and other psychedelics and how the combination of the misunderstanding of them with the crackdown on drug use in the 1970s lead to their designation of schedule 1 substances. But it’s important to note that you will also realize from this discussion just how different MDMA is compared to the average psychedelic. We end this discussion with a message of hope: there are going to be many people who are going to wonder what can they do to receive this MDMA therapy. We talk about what those clinical trials look like, what the enrollment looks like, and perhaps more importantly, what a compassionate use license would look like, such that if there are patients who are in need of this therapy (prior to its approval) they can have an understanding of the legal paths to doing just that.

We discuss:

Discovering MDMA, how Rick learned about it and his first experiences with it [9:45];
The timeline of MDMA’s evolution, the reinvention in the 1970s, “ecstasy”, the criminalization of MDMA [21:10];
Explaining the different “schedules” of drugs [30:55];
Rick’s fight to protect it for therapeutic uses, losing to the DEA despite winning in the court, the scientific community, and the media [38:25];
The risks involved with taking MDMA [42:30];
An incredible MDMA-LSD case study: Rick’s story of healing a treatment-resistant PTSD patient in the 1980s [44:45];
How and why MDMA was declared illegal on an emergency basis going against the judge’s recommendation after hearing Rick’s compelling case (and multiple appeals) in court [57:15];
Rick’s decision to study politics to affect change from the inside out, and the recent progress being made with the DEA [1:07:00];
Debunking the exaggerated risks of MDMA (e.g., neurotoxicity) [1:16:30];
Rick’s unbelievable ability to play the long game [1:28:45];
Which patients would not be good candidates for MDMA from a safety perspective? [1:34:30];
How MDMA is different from all other psychedelics, the importance of the setting, and Peter’s experiences with MDMA [1:36:30];
MDMA studies which lead to the crucial designation as a “breakthrough therapy” [1:40:30];
How someone with PTSD can get treated now through “expanded access for compassionate use” [1:46:00];
Rick’s ultimate goal and long term vision for psychedelic clinics [1:50:30];
Trip of Compassion documentary, and how psychedelics could change the world [1:52:30];
Rick’s early life: Resisting the draft, his feeling of wanting to change the world, and his profound experiences with LSD and other psychedelics [1:55:30];
The history of LSD and psilocybin, and the CIA’s interest in psychedelics [2:10:45];
Timothy Leary and the Good Friday Experiment [2:22:00];
Rick’s follow up study to the Good Friday Experiment, and his criticism (and praise) of Tim Leary [2:33:50];
Peter’s experience taking psilocybin [2:44:30];
The Concord Prison Experiment, and Rick’s follow up study 34 years later [2:47:00]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/rickdoblin/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#64 - Zol Kryger, M.D.: Navigating the sometimes shady world of plastic surgery—understanding potential complications of common procedures and how to reduce your risk by choosing the right doctor and asking the right questions Jul 29, 2019

In this episode, board-certified plastic surgeon, Zol Kryger, enlightens us about the frighteningly loose laws regulating the industry of plastic surgery, paving the way for a majority of cosmetic procedures being performed by doctors that are not board-certified plastic surgeons. We talk about some of the very serious complications that can occur even in “minimally invasive” procedures, where the incidence rate is only increased by the flood of non-certified doctors who want to offer these procedures to augment their income. Fortunately, Zol provides listeners with a very specific list of important questions to ask a surgeon when considering any of the many cosmetic procedures available. We then go into the specifics of the most common procedures and the risk of complications for each of them, including breast augmentation, tummy tucks, liposuction, Brazilian butt lifts, botox and fillers, facial peels and lasers, and more. By the end of this episode, you'll have a really clear understanding of what these risks are and how you can go about reducing those risks by choosing the right physician.

We discuss:

Why Zol chose plastic surgery [7:30];
The shockingly high percentage of plastic surgery being done by non-board certified doctors, and the laws that allow it to happen [11:20];
10 Questions to Ask Your Cosmetic Surgeon (PDF Download) [21:00];
Complications: Why you must ask your doctor about potential complications and how they would deal with them [24:20];
Zol’s first complication, how he dealt with it, and how having a partner to check your work is great for the doctor and patient [32:30];
Breast augmentation: What you need to know—types of implants, complication rates, and Zol’s summary of the safest and most effective way to do it [39:10];
Breast reconstruction following a mastectomy [1:06:30];
Tummy tuck: How it’s done, biggest risks involved, scarring, and how it can address hernias and diastasis [1:13:00];
Liposuction: How it works, the potential complications and risks involved, and the importance of choosing the right doctor in the “wild west” of liposuction [1:26:45];
Butt lifts: Rising popularity, major risks, the frighteningly loose laws regulating the industry, and how the butt lift industry is eerily similar to the subprime mortgage crisis [1:37:00];
What is it about plastic surgery (and not other segments of medicine) that compels (and allows for) untrained doctors to offer these procedures? [1:49:45];
Peter asks Zol if he ever feels emotionally conflicted working in an industry that sometimes can feed off the vanity and insecurity of people [1:56:25];
Does Zol ever turn down patients? [2:02:45];
The risks involved with botox, fillers, facial peels, and laser treatments [2:07:45]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/zolkryger/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

#63 - AMA #7: Exercise framework, deadlifting, lower back pain, blood pressure, nootropics, CGM, and more Jul 22, 2019

In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter’s head of research, asks the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed. You can also watch (or listen) to this full episode on our website at the AMA #7 show notes page. Questions continue to be pulled from the AMA section on the website, and any subscriber is welcome to submit questions for future AMAs.

We discuss:

What can I do to prevent/reduce interruptions in sleep due to needing to get up to urinate at night? [3:00];
Peter’s note card system for organizing his to-do lists [7:15];
How do I get smarter at reading/understanding the studies (or the media's interpretation of them) that get the headlines on health and/or disease? [11:15];
How can I obtain a continuous glucose monitor (CGM) as a non-diabetic individual? [11:55];
What is the most effective way to bring blood pressure down? [15:00];
Does Peter use any nootropics? [28:10];
Peter’s thoughts pertaining to concussions and head trauma [33:00];
Does Peter structure his exercise plan for lifespan or healthspan? [36:45];
How did Peter rebuild his lower back strength after his devastating injury during med school? [38:15];
Peter’s approach to deadlifting with a bad lower back [43:25];
Did Peter cave and buy a dog? [51:50]; and
More.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

#62 - Keith Flaherty, M.D.: Deep dive into cancer—History of oncology, novel approaches to treatment, and the exciting and hopeful future Jul 15, 2019

In this episode, Keith Flaherty, director of clinical research and targeted cancer therapy at Massachusetts General Hospital, shares his vast wealth of knowledge in cancer starting with the history of treatment from chemotherapy to radiation to surgical therapy and where those methodologies seemed to have leveled off. He also walks us through the timeline of advancements (and lack there of) from when the War on Cancer was declared in the 1970s, through the sequencing of the entire human genome, and all the way to today. Keith dives into the topic of immunotherapy, probably the most exciting recent development in cancer therapy, and also provides us a rundown of his notion of a different approach to cancer that attacks all the essential pillars of cancer growth and survival. Finally, we talk a little bit about liquid biopsies, we discuss the roles of CRISPR and other potentially over-hyped therapies with respect to cancer. We also touch on stem cell therapy a bit, as well as some other common cancer-related questions such as the role of vitamin D and sun exposure in melanoma, and much more.

We discuss:

Growing up around medicine, and finding a career that you love [7:30];
Medicine as a career, limitations of the med school teaching approach, and the dynamic and accelerating field of medicine and technology [16:30];
Explaining chemotherapy, radiation, and how a cancer develops [23:45];
Surgical oncology, cure rate of solid tumors, and survival rate after tumor removal [33:15];
25 years after the War on Cancer is declared, gene sequencing, and why Keith’s was fascinated by the HIV case study [37:15];
Cancer immunotherapy: History, how it works, and why some cancers respond and others don’t [46:00];
MHC complexes, and cancer cloaking mechanisms [56:00];
Comparative biology of cancer: Why some cancer can evade immune detection better than others [1:03:00];
What we learned from the Cancer Genome Atlas Project [1:07:00];
Defining targeted therapy, HER2 breast cancer, chronic leukemia, and the translocation of chromosomes [1:12:00];
Tumor protein P53, the most famous tumor suppressor gene and its ubiquity in cancer [1:17:45];
Activated oncogenes, the RAS pathway, PI3 kinase, RAF gene, and Keith’s “aha moment” [1:24:15];
Advice for starting your career as a scientist/clinician [1:37:00];
Fusion-driven cancers, targeted therapy, and the Bcr-Abl/chronic myelogenous leukemia case study [1:39:45];
Targeted therapy for fusion-driven solid tumors, adjuvant systemic therapy, and the HER2 breast cancer example [1:53:00];
Advancing melanoma treatment, survival, and cure rates with BRAF-MEK combo therapy [1:59:15];
The fundamental pillars of cancer growth and survival, and the toolkit we need to attack cancer from all angles [2:02:40];
Peter’s clinical framework for thinking about cancer and how Keith might improve it, and how the biotech environment is hampering our ability to put together novel cancer treatments [2:05:00];
How useful is CRISPR in terms of tumor suppressing? [2:16:15];
Liquid biopsies as a therapeutic monitoring tool [2:18:00];
Stem cell therapy: The efficacy and potential risks [2:25:15];
Aging and cancer: Is cancer inevitable? [2:28:45];
Vitamin D supplements, sun exposure, melanoma, and exercise [2:32:30];
How and why Keith has straddled the line between science/research and industry/drug companies, and the importance of getting more voices of practitioners at the table [2:42:00]; and
More.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

#61 - Rajpaul Attariwala, M.D., Ph.D.: Cancer screening with full-body MRI scans and a seminar on the field of radiology Jul 08, 2019

In this episode, radiologist/engineer, Raj Attariwala, explains how he was able to apply his engineering background to create a unique MRI scanner that is capable of constructing whole-body images with a resolution that is unmatched in the industry. Peter and Raj discuss the implications of such a robust, radiation-free imaging tool on the early detection of cancer. They dive deep into cancer screening and define terms such as sensitivity and specificity that are necessary to really understand this complex space. They then describe the biggest risks involved in this type of screening (false positives) and how Raj’s unique technology and process might drive down this risk substantially. But before that, they discuss all the common imaging technology from X-ray, to CT scan, to PET scans, to ultrasound, to MRI, and more. They touch on the history of each, how they work, the usefulness and limitations of each of them, as well as the varying risks involved such as radiation exposure. If you are interested in cancer screening and/or you’ve ever wondered how any radiology tool works, this episode is for you.

We discuss:

Raj’s road from engineering to radiology [7:45];
How X-ray works, the risk of radiation exposure, and the varying amounts of radiation associated with the different imaging technologies [18:00];
Computed tomography scans (CT scans): The history of CT, how it works, and why we use contrast [27:45];
Ultrasound: Benefits and limitations, and a special use for the heart [40:45];
Detecting breast cancer with mammography: When is works, when you need more testing, and defining ‘sensitivity’ and ‘specificity’ [51:15];
Magnetic resonance imaging (MRI): How it works, defining terms, and looking at the most common types of MRI [1:03:45];
Brain aneurysms: Using MRI to find them and save lives [1:23:45];
Raj’s unique MRI technology [1:30:00];
The risk of false positives in cancer detection, and how Raj’s MRI can reduce the number of false positives (i.e., increase specificity) [1:43:40];
The unique software Raj created to pair with his MRI machine [1:51:15];
Comparing the radiation exposure of a whole-body PET-CT to Raj’s equipment (DWIBS-MRI) [1:53:40];
How diffusion-weighted magnetic resonance imaging (DW-MRI) has revolutionized cancer screening [1:55:15];
Why a DW-MRI is still not a perfect test [1:59:00];
The potential for advancing MRI technology: Where does Raj think it could improve in the next 5-10 years? [2:03:00];
Are there any commercially available scanners that can match the resolution of Raj’s images? [2:06:00];
Machine learning: When and where might machine learning/AI impact the field of radiology? [2:08:40]; and
More.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

The one-year anniversary episode with Olivia Attia: Reflecting on the past year and looking forward to exciting times ahead Jul 02, 2019

In this anniversary episode, Olivia, Peter's daughter who initially kicked off The Drive podcast with her sneak peek episode, returns to ask Peter the tough questions on how the podcast is going, what he has learned along the way (and how he plans to make it better), what exciting things are in store for the future, and plenty more.

#60 - Annie Duke, decision strategist: Poker as a model system for life—how to improve decision making, use frameworks for learning, and apply ‘backcasting’ to boost your odds for future success Jul 01, 2019

In this episode, former World Series of Poker champion and author, Annie Duke, explains how poker is a pertinent model system for decision making in the real world, a system which blends imperfect information with some unknown percentage of both luck and skill. We go through the decision-making matrix, and how we spend most of our energy focusing on just one of the four quadrants at the expense of the learning opportunities that come from the other 75% of situations. Annie also shares how this evaluation of only the bad outcomes (and our tendency to judge others more harshly than ourselves in the face of a non-status quo decision), leads individuals, leaders, and teams to avoid bad outcomes at all costs. This avoidance is at the cost of the types of decisions which lead to progress and innovation both personally, and societally, across many realms from poker to sports to business to medicine. We also dive deep into a framework for learning, and the levels of thought required to rise to the top of a given domain. Finally, we talk about something that resonated deeply with me in terms of how I think about extending healthspan, which is the concept of “backcasting”.

We discuss:

Annie’s background, favorite sports teams, and Peter’s affinity for Belichick [7:30];
Chess vs. poker: Which is a better metaphor for decision making in life (and medicine)? [12:30];
Thinking probabilistically: Why we aren’t wired that way, and how you can improve it for better decision making [18:15];
Variable reinforcement: The psychological draw of poker that keeps people playing [25:15];
The role of luck and skill in poker (and other sports), and the difference between looking at the short run vs. long run [38:00];
A brief explanation of Texas hold ‘em [47:00];
The added complexity of reading the behavior of others players in poker [53:15];
Why Annie likes to “quit fast”, and why poker is still popular despite the power of loss aversion [58:30];
Limit vs. no limit poker, and how the game has changed with growing popularity [1:01:00];
The advent of analytics to poker, and why Annie would get crushed against today’s professionals [1:10:30];
The decision matrix, and the ‘resulting’ heuristic: The simplifier we use to judge the quality of decisions —The Pete Carroll Superbowl play call example [1:16:30];
The personal and societal consequences of avoiding bad outcomes [1:27:00];
Poker as a model system for life [1:37:15];
How many leaders are making (and encouraging) status-quo decisions, and how Bill Belichick’s decision making changed after winning two Super Bowls [1:41:00];
What did we learn about decision making from the Y2K nothingburger? And how about the D-Day invasion? [1:46:30];
The first step to becoming a good decision maker [1:48:45];
The difference between elite poker players and the ones who make much slower progress [1:55:30];
Framework for learning a skill, the four levels of thought, and why we hate digging into our victories to see what happened [1:58:15];
The capacity for self-deception, and when it is MOST important to apply four-level thinking [2:06:15];
Soft landings: The challenge of high-level thinking where there is subtle feedback and wider skill gaps [2:16:45];
The benefits of ‘backcasting’ (and doing pre-mortems) [2:19:30];
Parting advice from Annie for those feeling overwhelmed (and two book recommendations) [2:28:30]; and
More.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

#59 - Jason Fung, M.D.: Fasting as a potent antidote to obesity, insulin resistance, type 2 diabetes, and the many symptoms of metabolic illness Jun 24, 2019

In this episode, Jason Fung, nephrologist and best-selling author, shares his experiences utilizing an individualized approach to fasting to successfully treat thousands of overweight, metabolically ill, and diabetic patients, and why being a doctor who specializes in kidney disease gives him a unique insight into early indications of metabolic disease. We also have a great discussion on insulin resistance where Jason makes the case that we should actually think of hyperinsulinemia as the underlying problem. We also discuss the difference between time-restricted feeding, intermittent fasting, and dietary restriction (e.g., low-carb) and how they can be used to attack the root cause of T2D, metabolic syndrome, and obesity. We also have a fascinating discussion about the limitations of evidence-based medicine which leads to a conversation where we compare and contrast the scientific disciplines of medicine and biology to theoretical physics. We discuss:

Comparing scientific disciplines: Medicine and biology versus physics [7:25];
The limitations of evidence-based medicine [12:30];
Early signs of metabolic disease: How specializing kidney disease gives Jason a unique insight into early indications of illness [20:50]
Insulin resistance, hyperinsulinemia, and the overflow paradigm [29:30];
Why the common treatments for type 2 diabetes seem to make things worse [42:30];
How hyperinsulinemia (not insulin resistance) drives metabolic syndrome [53:15];
Insulin and weight gain, and using fasting to empty the cells of glucose [59:30];
The two step process of developing type 2 diabetes and how they are both manifestations of hyperinsulinemia [1:03:15];
NAFLD and hyperinsulinemia: A vicious cycle [1:08:30];
Are the features and symptoms of diabetes actually protective? [1:12:15];
Is obesity causing insulin resistance or is it the other way around? [1:17:30];
What role does inflammation play in obesity? [1:21:45];
CVD and cancer: Diseases of too much growth? [1:27:30];
How to reduce proliferation with rapamycin, nutrition, exercise, fasting, and manipulating hormones [1:32:45];
Getting patients to fast: How Jason and Peter utilize fasting in their practice, and how their approach differs [1:40:15];
Comparing bariatric surgery to fasting as a treatment for type 2 diabetes [1:48:00];
Why people think that fasting is bad for you [1:55:15];
Time-restricted feeding and intermittent fasting: Defining terms, and how Jason applies them in his practice [1:58:30];
A fasting case study: A diabetic patient with a non-healing foot ulcer [2:04:00];
Keys to a successful fast [2:12:45];
Muscle loss during fasting, and why Jason isn’t worried [2:24:45];
Will fasting help a healthy person live longer? [2:31:30];
Does fasting cause gallstones? [2:38:45]; and
More.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

#58 – AMA with sleep expert, Matthew Walker, Ph.D.: Strategies for sleeping more, sleeping better, and avoiding things that are disrupting sleep Jun 17, 2019

In the first three parts of our series with sleep expert Matthew Walker, Matt revealed the many reasons why we need sleep as well as the many short- and long-term dangers of not sleeping enough. In this special AMA episode, Matt comes back to provide a dissertation on listener’s questions about HOW to sleep. He answers questions from subscribers that largely focus on the practical and tactical ways we can improve our sleep in terms of duration, quality, consistency, and avoidance of the common things that are standing in the way the best sleep possible. We discuss:

Matthew’s TED Talk, and his favorite public speakers [7:45];
How good are the current sleep trackers like Oura, Fitbit, etc.? [10:45];
Is it bad to eat food too close to bedtime? [15:30];
How does exercise impact sleep? [17:30];
How is appetite affected by our sleep quality? [21:30];
Anxiety, cortisol, and weight gain: An awful feedback loop of sleep deprivation [23:30];
How to optimize your wind down routine: lights, temperature, & relaxation [26:10];
How alcohol disrupts sleep (and contributes to Alzheimer’s disease) [46:00];
Sleep’s impact on sex hormones, and romantic relationships [50:00];
Performance, accuracy, and minimizing the damage of shift work [55:30];
Bed partners: How to sleep in separate beds and retain a good relationship [59:30];
Can we use sound machines and electrical stimulation to improve sleep? [1:02:40];
Will we ever be able to “supercharge” our sleep stages using technology? [1:08:30];
Why sleep is the best insurance policy for lifespan and healthspan [1:11:45];
Melatonin: How (and how not) to use it for sleep improvement [1:19:00];
The dangers of sleeping pills, useful alternatives, and cognitive behavioral therapy for insomnia [1:28:30];
Can CBD and THC be used for sleep? [1:43:30];
Why haven’t we been able to develop a really effective sleeping aid? [1:50:40];
Can you get too much sleep? [1:55:50];
What to do (and not do) immediately following a terrible night of sleep? [2:09:15];
Why a consistent wake up time is king [2:14:30];
Does poor sleep speed up the aging process? [2:16:00];
Can different people be more (or less) resilient to sleep deprivation? [2:22:50];
Finding your optimal sleep schedule and determining your sleep chronotype [2:27:45];
Defining sleep efficiency and how to improve it [2:33:25];
Correcting insomnia: A counterintuitive approach [2:35:45];
How can parents improve the sleep of their kids? [2:41:30]; and
More.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

#57 – Rick Rubin, legendary music producer: collaborating with sensitive psyche of greatest living musicians, and his personal story of weight loss and spiritual quest Jun 10, 2019

In this episode, Rick Rubin, legendary music producer and co-founder of Def Jam Records and American Recordings, discusses his early foray into music production which started as a hobby as a teenager and ultimately turned into a Grammy award-winning career that produced revolutionary changes in the music industry. Rick has worked with the likes of the Beastie Boys, Red Hot Chili Peppers, and Johnny Cash, just to name a small fraction. Rick talks about the pain and suffering that sometimes drives music and the cycle of drug addiction and how he has been able to help artists through those struggles to make space for their creative genius. We also get into Rick’s own personal health journey including his battle with depression, his struggle with obesity, and ultimately his extraordinary transformation. Finally, Rick shares a really significant health scare which required emergency heart surgery, and how that experience has impacted him.

We discuss:

Early career, and the birth of hip hop [7:15];
Early success of Def Jam Recordings, and working with LL Cool J [13:15];
Revolutionary changes in music: LL Cool J, Beastie Boys, and Run DMC [19:30];
Partnership with Columbia Records, and leaving Def Jam [26:45];
The success of Licensed to Ill: how it took off, and how it changed things [36:00];
American Recordings: Rick’s transition to rock and roll [39:15];
Working with the Red Hot Chili Peppers, and the poetic nature of music [45:45];
Rick’s favorite music that he did NOT produce [53:00];
Prevalence of drug use and emotional pain in musicians: Rick’s experience with helping artists through their struggles [57:20];
NYC vs. LA hip hop [1:05:30];
Rick’s battle with depression [1:10:00];
Coping with the death of artists that Rick worked with [1:22:00];
Working with Johnny Cash [1:26:45];
Working with Rage Against the Machine [1:34:30];
The digital age of music: Have we lost something? [1:37:45];
Rick’s health journey and battle with obesity [1:42:45];
Radical weight loss: How Rick was finally able to shed the weight [2:00:15];
Total transformation: Exercise and training with Laird Hamilton [2:11:00];
Emergency surgery: Rick’s frightening heart condition [2:25:30];
Methylene blue and exogenous ketones: Are they neuroprotective? [2:46:15];
The most profound thing Rick learned about himself from his heart condition and major surgery? [2:52:30];
What life lessons does Rick wish to impart on his son? [2:57:30]; and
More.

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#56 - Jocko Willink, retired Navy SEAL, Part II of II: Sleep, fasting, raising kids, discipline, taking ownership, and the impact of war Jun 03, 2019

In the second installment of this 2 part series, Jocko shares his sleep routine and attitude towards sleep, we talk about his meals (and occasional indulgences), his experience with fasting, and touch briefly on his workout routine. Jocko explains his approach to leading a family, instilling values in his kids, and working with others who may not share your same principles. We also find out what prompted Jocko to make discipline the underpinning principle of his life, when it might make sense to quit, and the philosophical topics such as free will, mindset, and whether or not you can change someone. We also discuss 9/11 and the war in Iraq and Afghanistan, the future of warfare, and perhaps more importantly, how Jocko’s experience in combat has shaped and impacted his life to this day.

We discuss:

Where was Jocko when the 9/11 attack occurred? What did he think? [5:45];
How SEAL teams are structured, and which teams Jocko was on [10:45];
War in Afghanistan: Unique challenges, how it differs from Iraq, and the lessons learned [13:00];
Iraq War: Differing public opinions on war, Jocko’s experiences in Iraq, strategic mistake of ISIS, and the Saddam regime [19:15];
The future of warfare: machine technology in war and medicine [27:30];
Raising kids, instilling values, and leading a family [33:45];
Sleep: Jocko’s habits, routine, and attitude towards sleep [40:15];
When it makes sense to quit [53:30];
What makes Jocko different, the existence of free will, and whether or not you can change people [1:01:45];
How to work with people with a bad attitude and opposing mindset [1:07:45];
Does Jocko ever indulge? Favorite foods and treats [1:11:00];
Fasting and meal timing [1:16:30];
Olivia (Peter’s daughter) interviews Jocko [1:21:45];
What prompted Jocko to start prioritizing discipline in his life? [1:22:15];
What does Jocko do in his workouts? [1:23:30];
Where did the nickname, Jocko, come from? [1:24:20];
Jocko’s favorite book, his best advice, and secret to getting up early [1:25:50];
The impact that war had on Jocko [1:28:00]; and
More.

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#55 - Jocko Willink, retired Navy SEAL, Part I of II: objective, strategy & tactics, leadership, protocols, dealing with death, and applying the many lessons learned from war May 27, 2019

In part 1 of this 2 part series, Jocko Willink, retired Navy SEAL, discusses some of his most important lessons learned from his time commanding some of the world’s most expert special forces operators including the importance of understanding the objective and strategy (and then tactics) of a mission, why humility is the greatest trait a leader can have (and certain times when it’s not), as well as the necessity of having proper protocols in place to deal with whatever comes your way. We also talk about how Jocko prioritizes his military and family obligations with his love for jiu-jitsu, as well as how to decipher what really matters in life. Finally, we go through the US history with respect to various wars from World War I, all the way forward, and much much more.

We discuss:

Objective, strategy, and tactics [6:00];
Training compared to actual combat [20:30];
The importance of humility in leadership, business, and life [33:00];
The dichotomy of human traits: Can you be too humble? [49:00];
Why many leaders lack humility [52:30];
Why Jocko wanted to be a Navy SEAL [55:00];
Jocko’s attitude toward death, and dealing with the death of a soldier [58:45];
The vital importance of protocols [1:03:45];
Protocol for losing a child (or anyone close to you) [1:15:00];
Protocol for getting dumped, and some relationship advice [1:18:00];
How to differentiate between things that matter and things that don’t [1:24:30];
Jocko shares his experience during BUD/S [1:35:45];
How Jocko prioritizes his family and SEALs obligations: Would Jocko come out of retirement and go back to war? [1:48:30];
America’s lost sense of connectedness and purpose since WWII [1:59:00];
How warfare has evolved over the decades since WWI [2:05:40];
Obeying orders and the obligation to dissent [2:09:00];
WWI and WWII, the beginnings of “decentralized command” [2:15:00];
The American warrior mentality, and the impact of freedom on a society [2:20:45];
What impact can an individual president really have? [2:25:00];
The Korean war [2:29:15];
Lessons learned from Vietnam [2:31:10];
First Gulf War, Iraq War, and The War in Afghanistan [2:35:45]; and
More.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In part 1 of this 2 part series, Jocko Willink, retired Navy SEAL, discusses some of his most important lessons learned from his time commanding some of the world’s most expert special forces operators including the importance of understanding the objective and strategy (and then tactics) of a mission, why humility is the greatest trait a leader can have (and certain times when it’s not), as well as the necessity of having proper protocols in place to deal with whatever comes your way. We also talk about how Jocko prioritizes his military and family obligations with his love for jiu-jitsu, as well as how to decipher what really matters in life. Finally, we go through the US history with respect to various wars from World War I, all the way forward, and much much more.

#54 – Kevin Sayer, CEO of Dexcom: Continuous glucose monitors – impact of food, sleep, and stress on glucose, the unmatched power of CGM to drive behavioral change, and the exciting future of CGM May 20, 2019

In this episode, Kevin Sayer, CEO of Dexcom, discusses the remarkable benefits of a continuous glucose monitor for the diabetes population. Peter shares his own invaluable insights he’s learned from wearing a CGM including the impact of sleep and stress on glucose as well as the unmatched power of a CGM to drive behavioral change. Kevin also reveals some of the exciting partnerships and future advancements of their products benefiting not only those with type 1 and 2 diabetes, but also for the growing community of people interested in optimizing health and wellness.

We discuss:

How they met, and Kevin’s path to becoming CEO of Dexcom [7:00];
How CGM technology works, and what makes Dexcom’s G6 the best model yet [15:15];
Challenges of working in the US healthcare system and getting CGM insured [21:45];
Developing an even smaller, more user-friendly, and less costly product while maintaining performance and accuracy [33:15];
Next thing on the horizon for type 1 diabetes patients [43:30];
The incredible accuracy of the G6, recommended over-the-counter glucose meters, and the unmatched power of CGM to drive behavioral change [48:15];
Software improvements for type 2 diabetics, and the remarkable benefits of real-time feedback for driving behavioral change [58:15];
Dexcom vs. the competitors, the less invasive options, and the fundamental problems needing to be solved with CGM technologies [1:07:00];
The cost of CGM, why you need a prescription, and when might there be a OTC option? [1:12:00];
Smartwatch integration, bluetooth technology, and exciting collaborations and partnerships [1:22:00];
Future places for CGM: Hospitals, nutrition apps, general health and wellness, and more [1:27:15];
Dexcom’s unique company culture [1:34:15];
Parenting advice from Kevin [1:37:30];
Lessons learned through failures and success [1:38:45]; and
More.

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#53 - AMA #6: Fasting framework, vitamin supplementation, antioxidants, time management, problem-solving, and more May 13, 2019

In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter’s head of research, asks the questions. If you’re listening on a podcast player, you’ll be able to hear a preview of the AMA.

If you’re a subscriber, you can watch or listen to this full episode on our website at the AMA #6 show notes page.

PLEASE NOTE: We are currently building a private RSS feed that will allow subscribers to listen uninterrupted on the podcast player of their choice. This will be released shortly.

Questions are pulled from the AMA section on the website (peterattiamd.com). Any subscriber is welcome to submit questions.

We discuss:

Vitamin supplementation: Is it necessary if you eat a balanced diet? [2:00];
Antioxidants: What does current science have to say about antioxidants in food and supplements? [9:00];
How do you break a fast of more than three days? [17:15];
Does a morning black coffee break a fast? In other words, does black coffee raise insulin levels? [22:15];
When intermittent fasting, does the placement of the “feeding window” matter? [25:30];
Is it better to fast before or after a planned food binge (e.g., Thanksgiving)? [28:30];
Fasting protocol: Do you have a specific protocol to recommend? [31:30];
Time management: How do you manage your time between work, family, and your many personal interests? [35:45];
Problem solving: Can you breakdown your process of problem-solving? [46:45];
For those looking to gain a better understanding of biochemistry, pharmacology, etc., do you have any good textbooks or (online) resources to recommend? [49:00];
What are some of your favorite podcasts that you listen to? [51:15];
What is your favorite animal? [54:45]; and
More.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

#52 - Ethan Weiss, M.D.: A masterclass in cardiovascular disease and growth hormone - two topics that are surprising interrelated May 06, 2019

In this episode, Ethan Weiss, Hopkins trained preventative cardiologist at UCSF, discusses two topics that on the surface may seem unrelated which is cardiovascular disease, and the role of growth hormone and IGF in disease. Ethan provides a masterclass in everything from acute coronary syndrome to all of the complex nuances around stent placement, as well as how calcium scores and results from CT angiograms shape his treatment of patients. He also shares how his idea to study the sex differences in blood clotting as it relates to coronary disease lead him to pursue the field of endocrinology, and specifically what he found with respect to the effect of growth hormone and IGF on the liver, the brain, and overall human longevity.

We discuss:

Mutual love for hockey [7:15];
Ethan’s background and interest in cardiology [13:15];
Clinical definitions of a heart attack, clotting, and plaque: What causes the acute event? [24:15];
Defining coronary disease and myocardial infarction: The evolving nomenclature [32:00];
What happens when someone comes to the ER with a STEMI (ST elevation myocardial infarction)? [47:15];
Stents [54:45];
Treatment protocol for both acute and chronic coronary artery disease: History, controversy, and important distinctions [1:06:30];
Using stents to treat stable angina: What we learned from the COURAGE AND ORBITA trials [1:15:30];
The “art” of longevity: The challenge of preventative medicine and understanding risk [1:31:45];
Understanding CAC scores, and CT angiogram results [1:40:15];
How sex differences in clotting and heart disease got Ethan interested in growth hormone and IGF [2:01:00];
Impact of growth hormone on the liver [2:07:00];
Growth hormone and insulin sensitivity [2:18:00];
The role of GH and IGF on chronic disease and cancer [2:23:30];
Will taking growth hormone promote longevity? [2:32:30];
GH and IGF as a treatment for early stage dementia? [2:34:30];
What happens to IGF while fasting and what about fasting improves longevity? [2:35:15];
The importance of becoming scientifically literate and making science more exciting for future generations [2:38:30];
Ethan’s new company: Keyto [2:43:45]; and
More.

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The Ayrton Senna Episode (re-release): Celebrating the greatest driver in Formula 1 history and the cautionary tales of driven individuals May 01, 2019

To celebrate the life of the legendary Formula 1 driver Ayrton Senna, 25 years to the day of his tragic death, we are re-releasing this bonus episode. In this episode, Peter and med school colleague (and brilliant psychiatrist) Paul Conti reminisce on their favorite moments in Formula 1 history, their deep admiration for the late Ayrton Senna, and the remarkable careers of their favorite drivers. Paul also helps to illuminate the psychological components that made the luminary drivers great, and the cautionary lessons we can take from their incredible lives.

We discuss:

Who is Ayrton Senna? [3:47];
How Senna’s death changed the sport [9:52];
The 80s & 90s: a remarkable era of Formula 1 [12:57];
Hypothesizing what caused Senna’s fatal crash [17:47];
Comparing Stewart and Senna, their incredible bravery, and what lessons we can learn from them [23:32];
Best documentaries on racing, and some of Senna’s best moments [31:02];
Gilles Villeneuve, Stefan Bellof, and some of the other greats [39:17];
Why Senna is widely acknowledged as the best of all time [46:17];
Great rivalries and personalities [49:32];
Rendezvous, a high-speed drive through Paris [56:52]; and
More.

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#51 - Robert Sapolsky, Ph.D.: The pervasive effect of stress - is it killing you? Apr 29, 2019

In this episode, Robert Sapolsky, Ph.D., discusses the widespread impact of stress on our physical and emotional health as well as the mechanisms by which it can precipitate chronic illness, dementia, depression, and more. He also provides insight into the factors that contribute to the stress response (and our ability to handle it) such as social rank, personality, environment, and genetics. Lastly, we discuss how our behavior is altered in the face of stress and how that not only has a pervasive effect on a personal level, but also on society as a whole in how we interact with each other.

We discuss:

Background, interest in stress, and Robert’s time in Kenya studying baboons [7:00];
Physiology of a stress response, and why it’s ingrained in our DNA [14:00];
Individual variation in the response to stress, and how everyone has a different optimal level [24:00];
How social rank and personality differences affect our stress response [30:15];
What’s happening in the brain when faced with stressful situations? [39:15];
What makes the human brain different than all other species? [48:15];
Imprinting stress to your kids epigenetically [52:00];
The role of stress on memory and the consequences of hypercortisolemia [57:15];
The impact of subjective socioeconomic status and social media on stress levels and health [1:01:45];
Tips for managing stress in the modern world [1:17:45];
What Robert learned about himself studying the social behavior of baboons [1:29:30];
The multilayered factors behind every human behavior, the context of “good and bad,” and exploring the human capacity of the wild extremes of violence and altruism from moment to moment [1:34:30];
PMS: How two women with identical hormone levels can have completely different emotional experiences [1:39:00];
How much of a role do genes play in depression and other emotional states? [1:42:45];
Why is cortisol elevated under sleep deprivation? [1:50:15];
The impact of stress on cancer [1:54:30];
The impact of stress on atherosclerosis, dementia, addiction, and depression [2:01:15];
Impulsiveness, impaired judgement, and lack of empathy in times of stress [2:05:45];
What advice would Robert give his 25-year-old self? [2:12:45]; and
More.

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#50 - AMA #5: calcium scores, centenarian olympics, exercise, muscle glycogen, keto, and more Apr 22, 2019

In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter’s head of research, asks the questions. If you’re listening on a podcast player, you’ll be able to hear a preview of the AMA.

If you’re a subscriber, you can watch or listen to this full episode on our website at the AMA #5 show note’s page.

PLEASE NOTE: We are currently building a private RSS feed that will allow subscribers to listen uninterrupted on the podcast player of their choice. This will be released shortly.

Questions are pulled from the AMA section on the website (peterattiamd.com). Any subscriber is welcome to submit questions.

We discuss:

Coronary calcium score: what it means and how to interpret your results [1:15];
How to train for the “centenarian olympics” [18:00];
Explaining the blood glucose response to various types of exercise [35:30];
The Tabata protocol [43:15];
Exercising on a ketogenic (or low-carb) diet: performance, muscle glycogen, adaptation, and more [49:30];
The work of Dr. Gabor Maté and its impact on Peter [54:15];
What's the best book you've read in the past year? [55:45];
What is “pattycakes?” [59:00];
What is the latest and greatest of egg boxing [59:30]; and
More.

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#49 – Matthew Walker, Ph.D., on sleep – Part III of III: The penetrating effects of poor sleep from metabolism to performance to genetics, and the impact of caffeine, alcohol, THC, and CBD on sleep Apr 15, 2019

In the final part of this 3 part series, Matthew Walker, professor of neuroscience at UC Berkeley and expert on sleep, discusses the omnipresent effects of insufficient sleep on everything from metabolism, appetite, athletic performance, decision-making, productivity, leadership, mental health, genetics, memory, and more. We also discuss the impact of caffeine and alcohol on sleep quality, the efficacy of sleep aids such as THC and CBD, and much more.

We discuss:

Sleep and insulin resistance [6:15];
Epigenetic changes with insufficient sleep, and the reversibility of lost sleep [18:00];
Sleep’s impact on exercise performance, appetite, and food choices [28:15];
Decision making, workplace production, leadership qualities, physical attractiveness, and more [43:15];
The broken water pipe analogy [49:30];
The negative effect of caffeine, alcohol, and high carb meals on sleep quality [53:30];
The efficacy of THC and CBD as sleep aids [1:05:30];
Sleep and mental health: A two-way street [1:16:45];
How sleep impacts memory, and Matthew’s current and upcoming projects [1:24:00];
Sleep’s impact on athletes: Looking at Formula One drivers [1:32:45]
Translating the science to clinical application [1:57:00]; and
More.

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#48 – Matthew Walker, Ph.D., on sleep – Part II of III: Heart disease, cancer, sexual function, and the causes of sleep disruption (and tips to correct it) Apr 08, 2019

In part 2 of this 3 part series, Matthew Walker, professor of neuroscience at UC Berkeley and expert on sleep, describes the preponderance of evidence linking poor sleep to cardiovascular disease, cancer, and sexual function. He also details the impact of cortisol on our nervous system contributing to sleep disturbances and insomnia as well as the efficacy and risks associated with the most common sleeping pills. Matthew also describes the sleep needs of teenagers and urgently lays the case that we should reconsider school start times. We also get into the effect of electronics at night, the efficacy of napping, the general impact of modern society on our sleep habits, and what changes we can make to course correct.

We discuss:

Sleep and cardiovascular disease [6:00];
Fuel partitioning and dieting while sleep deprived [16:45];
Sleep and the reproductive function: testosterone, sperm count, FSH, menstrual cycles, and fertility [19:45];
The biological necessity of sleep, the lack of a “safety net”, sleep debt, and ways to course correct sleep problems [23:45];
Fighting cancer and improving immune function with sleep [34:30];
The medical profession: A culture that devalues sleep [47:30];
The sleep needs of children, the travesty of early school start times, electronics at night, and advice for parents [1:04:45];
How exposure to light affects sleep, and how modern society has changed our sleep habits [1:26:15];
Is napping helpful? [1:36:00];
The effect of cortisol levels on sleep [1:41:15];
Are sleeping pills doing more harm than good? [1:52:15]; and
More.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

#47 – Matthew Walker, Ph.D., on sleep – Part I of III: Dangers of poor sleep, Alzheimer's risk, mental health, memory consolidation, and more. Apr 01, 2019

In part 1 of this 3 part series, Matthew Walker, professor of neuroscience at UC Berkeley and expert on sleep, describes the different stages and cycles of sleep, including what he calls the 4 pillars of sleep, and how they contribute to memory consolidation and numerous important pathways to mental health. We also get into the dangers of chronic sleep deprivation, such as the development of dementia, and the more acute dangers of sleep deprivation like fatal car crashes which are most often caused by drowsy driving. We also discuss the different and important roles of REM vs. non-REM sleep, and the impact that bad sleep habits can have specifically on those sleep stages.

We discuss:

Matthew’s background and interest in sleep [6:03];

Sleep and Alzheimer’s disease, and the 4 pillars of sleep [12:18];

Stages of sleep, sleep cycles, and brain waves [41:18];

Memory and sleep, and the risk of insufficient REM sleep [55:48];

Evolutionary reasons to sleep [1:02:03];

The early riser vs. the night owl, and tips for overcoming jet lag [1:10:18];

Is there one type or stage of sleep that is most important? [1:17:33];

The dangers of drowsy driving [1:28:48];

The timeliness of Matthew’s book, and how the conversation of sleep has changed over the past several years [1:35:18]; and

More.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

#46 - Chris Masterjohn, Ph.D.: Navigating the many pathways to health and disease - NAD and sirtuins, methylation, MTHFR and COMT, choline deficiency and NAFLD, TMAO, creatine, and more Mar 25, 2019

In this episode, Chris Masterjohn, entrepreneur, independent researcher, and doctorate in nutrition, elucidates the latest research on the risk and benefits of NAD supplements, and shares his personal intuition on the topic. We also dive deep into choline deficiency and its role in the rising prevalence of nonalcoholic fatty liver disease. From there, Chris enlightens us on the importance of methylation, a simple yet profoundly important biochemical process affecting our physical and mental health. He also describes the variations of the genes MTHFR and COMT, enzymes which play important roles in methylation and which have profound impacts on our well-being.

We discuss:

Chris’s background, falling in love with biochemistry, and decision to pursue research over medicine [7:45];
Choline: what it is, why it is important, and how a deficiency can cause non-alcoholic fatty liver disease [11:45];
NAFLD: increasing prevalence and potential causes [25:00];
TMAO: Should we be worried about the TMAO content in choline and our foods? [39:15];
Types of fatty acids: How they may predispose us to different types of illnesses [53:30];
Why don’t we see low VLDL in patients with NAFLD? [59:45];
Understanding flux, and how machine learning may affect medicine in the near future [1:03:15];
NAD: How it works, supplements, sirtuins, and the central role of the liver [1:09:30];
Intravenous NAD [1:33:00];
Oral NR: Is it the optimal way to get more NAD? [1:38:30];
What is the possible harm of taking an NAD precursor? [1:47:15];
The MTHFR gene [1:49:45];
The methylation pathway [1:58:15];
The COMT gene [2:04:30];
Creatine: The uses and benefits and its important role in methylation [2:10:15];
Dietary strategies for MTHFR: choline, creatine, folate, and glycine [2:16:45];
How to mitigate the negative effects of NAD supplements [2:23:45];
A case study of a person with high homocysteine [2:28:00];
What is the level of evidence that you need to take action? [2:32:15];
Does Chris supplement with NAD precursors? And can it improve symptoms of rosacea? [2:35:45];
Decision making in the face of inconclusive data, and trying to disentangle the placebo effect [2:39:00];
What does Chris believe to be true that very few people would agree with him about? [2:43:15];
How to follow Chris’s work [2:48:45]; and
More.

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#45 - AMA #4: sleep, jet lag protocol, autophagy, metformin, and more Mar 18, 2019

In this “Ask Me Anything” (AMA) episode, the first subscriber-only edition, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter’s head of research, asks the questions.

As a reminder, AMAs are for subscribers only. If you want to subscribe, you can learn more about the benefits at https://peterattiamd.com/subscribe. If you are a subscriber, you can watch or listen to this in full on the show notes portion of our website. If you are listening to this on a podcast player, you will hear a sneak peek of this AMA and then will have to finish listening or watching on the website.

All questions are pulled from the AMA section on the website (https://peterattiamd.com/ask-me-anything/). Any subscriber is welcome to submit questions.

We discuss:

Blue light blockers and how they improve sleep [1:30];
How to minimize jet lag and sleep disruption while traveling [6:45];
How to treat symptoms of PMS, the female hormone cycle, testosterone in women, and estrogen in men [15:45];
Autophagy: what it is, why it matters, and how can we enhance it [26:15];
The two-minute drill (and a bonus Patriots and Tom Brady tangent) [41:15];
Has Peter thought about having CME accredited content for people in the medical field? [44:15];
How does one find good doctors that are somewhat up to date on the latest research, primary care, etc.? [45:45];
What values would Peter be interested in monitoring continuously if the tech existed? [47:15];
How to annoy Peter [49:15];
If I'm interested in longevity, should I do a Ph.D. or M.D.? [50:00]; and
More.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

#44 - Jeremy Schaap, ESPN journalist: upsets, doping, triumphs, and the importance of sports Mar 11, 2019

In this episode, Jeremy Schaap, preeminent journalist at ESPN, discusses two of the most incredible upsets in boxing history, both of which Jeremy has expertly covered during his illustrious career, most recently culminating in the 30 for 30 special, 42 to 1. We also discuss his infamous Bobby Knight interview, his coverage of the doping scandals in baseball and cycling, as well as the pressures of following in his father’s enormous footsteps who taught him the importance of fairness in journalism. Additionally, we discuss the deeper meaning of sports, what it teaches us, and how he uses sports as a platform to bring light to greater societal issues.

We discuss:

Jeremy and Peter’s shared obsession with boxing history [5:15];
Cinderella Man: The incredible upset of Max Baer by James Braddock, and the rise of the great Joe Louis [9:00];
42 to 1: Buster Douglas beats Mike Tyson for one of the most unlikely upsets in the history of sports [23:30];
Contrasting fighting styles from “destroyers” to “artists”, and comparing the auras of the all-time greats [36:30];
Mike Tyson’s take on the Douglas fight, what went wrong for Buster Douglas following his victory, and other incredible upsets in sports history [45:30];
Ranking the greatest boxers since the 1960s [54:00];
Jeremy’s famous Bobby Knight interview: A career defining moment [57:00];
The pressures of following his father’s career path, and what it means to be a fair journalist [1:01:30];
The meaning of sports: how it brings us together and gives us a platform for bigger discussions [1:11:00];
Jeremy’s biggest regret in reporting, the 1998 home run chase, and the doping scandals of baseball and cycling [1:17:30];
The biggest and most underreported stories in sports [1:26:45];
Best 30 for 30 episodes: Jeremy and Peter pick their favorites [1:31:30];
Baseball: Steroids and the hall of fame [1:34:30];
Final thoughts on what makes sports so special [1:37:45]; and
More.

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#43 - Alan Bauman, M.D.: The science of male and female hair restoration - how to protect, enhance, and restore the appearance and health of the hair and scalp Mar 04, 2019

In this episode, Alan Bauman, certified hair transplantation surgeon and hair restoration expert, discusses both male and female pattern hair loss, the science behind what drives it, and what that tells us about prevention and restoration. Having treated over 20,000 patients, Alan shares his invaluable insights into what works and what doesn’t in terms of the non-surgical treatment options. We also go into great detail about the more invasive approaches like PRP, and of course, hair transplantation, a procedure which Alan has refined over the years into a proprietary method that seems to produce unbelievable results. Additionally, Alan provides tips for maintaining scalp health, which is vital for hair growth, as well as the importance of choosing a hair specialist who has the tools, expertise, and patience to develop a compassionate and encompassing approach to hair restoration.

We discuss:

Alan’s unique path, and how he became interested in hair transplantation [7:15];
The prevalence of hair loss, types of hair loss, and the different patterns in men vs. women [15:45];
The role of genetics in hair loss, and when does it start [19:00];
Female hair loss: the role of hormones, pregnancy related hair loss, and what it means to have thinning and shedding [22:30];
Primary drivers of male hair loss, finasteride as a treatment, and the potential side effects [26:15];
Common treatments - Proscar, Propecia, Rogaine, and more - how they all came about and what you need to know [29:45];
Primary drivers of female hair loss, potential treatments, and the different types of hair follicles [33:15];
What are some of the unproven/snake oil methods of hair treatments being pushed to the public? [37:15];
Preventative steps to take if you’re worried about future hair loss [42:00];
Medications that may negatively affect hair quality [45:30];
The importance of seeing a hair specialist [47:15];
Impact of scalp health and inflammation on hair growth, how to pick and apply shampoo and conditioner, and how to avoid and treat hair breakage [50:15];
Treatment options - finasteride, minoxidil, laser caps - how they work and what you need to know [57:15];
PRP treatment: How it works, details of the procedure, and Alan’s proprietary protocol [1:11:45];
The hair transplant procedure [1:29:30];
Risks involved with a hair transplant procedure [1:44:00];
Is a donor hair susceptible to the forces of the implant site that caused the hair loss? Can a hair follicle grow anywhere on the body? [1:47:45];
Age appropriate procedures, how far the field has come, and why Alan loves his work [1:51:45]; and
More.

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#42 - Avrum Bluming, M.D., and Carol Tavris, Ph.D.: Controversial topic affecting all women—the role of hormone replacement therapy through menopause and beyond—the compelling case for long-term HRT and dispelling the myth that it causes breast cancer Feb 25, 2019

In this episode, Avrum Bluming, hematologist, medical oncologist, and emeritus clinical professor at USC and Carol Tavris, social psychologist and author of Mistakes Were Made (But Not By Me), discuss their collaboration on their recent book, Estrogen Matters. Their book takes on the very polarizing and confusing topic of hormone replacement therapy for women suffering with symptoms of menopause. In many ways, the story and history of HRT is in striking parallel to the bad science that led up to the dietary guidelines being set forth in 1980. Carol and Avrum make a compelling case that most women benefit greatly from being on postmenopausal hormone replacement therapy, and can do so without increasing their risk of breast cancer. We also cover the history of HRT, the impact of the Women's Health Initiative, and take a deep dive into each of the clinical conditions for which HRT should be considered, such as cardiovascular disease, neurodegenerative disease, and osteoporosis, to name a few.

We discuss:

The background of Carol and Avrum, and the impetus for writing Estrogen Matters [8:45];
The sad early history of hormone replacement therapy, treatments for prostate and breast cancer, and the difference between the treatment of women vs. men [14:00];
What hormones do, and why they drop off rapidly in women compared to gradually in men [20:15];
Mistreatment of women leading to great skepticism [23:45];
Breast cancer vs heart disease: Comparing the incidence and mortality in women [27:00];
Case studies of women suffering symptoms of menopause [30:00];
What are Carol and Avrum’s true motivations in this endeavor? [32:45];
The changing perceptions of HRT, the impact of the Women’s Health Initiative (WHI), and the problems with the WHI [37:45];
Is this one big conspiracy? The uncanny resemblance of the story of HRT and how the dietary guidelines were created [46:00];
Why people (falsely) think estrogen causes a 25% increase in breast cancer, and a lesson in absolute vs. relative risk [57:15];
The truth about progesterone and cancer risk, and the best types of estrogen and progesterone to be taking [1:09:00];
The Women’s Health Initiative: the reported findings, walking back their bold claims, and their hesitance to admit they were wrong [1:17:45];
Brain benefits of HRT, Alzheimer’s disease in women, and estrogen as a preventative treatment for AD [1:22:45];
The impact of HRT on heart disease, the ideal time to start HRT, and the risks associated with HRT [1:26:45];
The benefits of estrogen on bone health, and the incidence and mortality of hip fractures [1:33:15];
Colon cancer: Can HRT reduce the risk of colon cancer? [1:38:15];
Diabetes: Can HRT reduce the risk of developing diabetes? [1:40:30];
The downsides of hormone replacement therapy (HRT) [1:41:30];
How to approach your doctor who may already have a very strong point of view about HRT [1:42:15];
What kind of research needs to be done to answer the remaining questions about the benefits and risks of HRT? [1:48:30];
Cancer: Our evolving understanding and the future of treatment [1:59:15];
Welcoming the critics: Avrum and Carol want to start a conversation [2:02:00];
Are there racial differences in benefits and risks with HRT? [2:04:15];
The reactions to Estrogen Matters, and why it is a must read [2:09:15];
HRT after a diagnosis of breast cancer [2:13:45]; and
More.

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#41 - Jake Kushner, M.D.: How to thrive with type 1 diabetes and how everyone can benefit from the valuable insights Feb 18, 2019

In this episode, Jake Kushner, pediatric endocrinologist specializing in helping people with type 1 diabetes, discusses the best strategies to live and thrive with T1D, especially as it relates to diet and exercise. We also discuss why many patients who control their blood sugar with high amounts of exogenous insulin are at a substantially higher risk than people who can control their blood sugar at lower levels of insulin. This concept has great implications for non-diabetics as well considering the increasing prevalence of diseases related to insulin resistance. We also cover some of the basics, the history, the increasing prevalence of type 1 diabetes, and more importantly, what we can do to help kids with this disease, and their families. We discuss:

How Jake became interested in type 1 diabetes [5:30];
The pathophysiology of type 1 diabetes, the increase in prevalence, and the role of beta cells [17:00];
The role of body weight and BMI in the risk of developing T1D [27:00];
Genetics of T1D and the risk of inheritance [32:00];
Hemoglobin A1c [36:15];
Insulin: the amazing story of its discovery, its effect on cellular metabolism and IGF-1, and why the hell it’s so expensive [39:15];
Diabetes Control and Complication Trial: blood glucose and the complications associated with diabetes [54:45];
Cognitive impairment, epigenetic changes, and other dangers associated with high, peak blood glucose, and big swings in blood glucose levels [1:09:15];
Depression, anxiety, and other challenges of living with T1D [1:15:30];
Jake’s realization that the current standard of care of T1D is inadequate [1:26:15];
Managing diabetes with exercise [1:30:15];
The Bernstein method, and protein’s impact on glucose and insulin [1:36:15];
Jake radically changes his approach to treating patients [1:45:00];
What other tools are there for controlling T1D? [1:49:45];
Is the ketogenic diet appropriate for those with T1D? [1:52:45];
The most important lessons that can be applied by the non-diabetic population [1:59:00];
The two dream measurements Peter wishes were available [2:04:00]; and
More.

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#40 - Tom Catena, M.D.: The world’s most important doctor – to nearly a million patients – saving countless lives in the war-torn and remote villages of Sudan Feb 11, 2019

In this episode, Tom Catena, a missionary physician who runs Mother of Mercy Hospital in the Nuba Mountains in Sudan, describes some of his extraordinary work as the only doctor in a remote, war-torn region of Africa. In terms of individual lives saved, you could argue that there is no other person on the front lines doing more than Tom. Additionally, we explore the manner in which the Nuba people die, which is in striking contrast the ubiquity of chronic disease and self-harm in the west, despite the extreme poverty and unimaginable suffering experienced by the Nuba people. Lastly, we discuss the lessons to be gleaned from the Nuba people, who despite their suffering, live so harmoniously, happily, and resiliently. To support Tom’s mission please visit www.amhf.us.

We discuss:

Background, medical training, and early days of missionary work in Africa [9:00];
Tom arrives at Mother of Mercy Hospital in the Nuba Mountains of Sudan, civil war breaks out, and his staff evacuates [15:45];
Learning surgery on the job and earning the trust of the community [40:45];
The amazing people of Nuba, and why Nuba feels like home to Tom [51:30];
NY Times article about Tom’s work, and Tom’s new venture on the board of Aurora Prize Foundation bringing awareness and funding to other missionaries doing great work [1:03:30];
Tom’s mind-blowing ability to deal with chaos while seeing hundreds of patients per day [1:15:45];
The most afraid Tom has ever been, and how he copes with the emotional trauma of his daily experiences [1:23:30];
The basic tools, technologies, and medicines that Tom is lacking that could save many lives [1:33:30];
The logistical challenge of helping Tom’s hospital, and what Tom really needs [1:39:15];
Diseases in the adult population [1:42:30];
Living without possessions, finding meaning, and being a missionary [1:59:30];
Sense of purpose, happiness, and suicide: Contrasting the US with Nuba [2:11:00];
Other than donations, is there a way people can help Tom and other similar causes? [2:19:15];
The food in Nuba [2:22:30];
Tom’s annual bout of malaria [2:27:30];
Patients that Tom will never forget [2:29:45];
Resources for people wanting to get involved in helping Tom’s work [2:34:45];
Peter tells a story that defines Tom [2:36:00]; and
More.

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#39 - Ted Schaeffer, M.D., Ph.D.: How to catch, treat, and survive prostate cancer Feb 04, 2019

In this episode, Ted Schaeffer, Professor and Chair of the Department of Urology at Northwestern (youngest chairman in the country), presents the roadmap for the best way to screen for, and treat, prostate cancer. We also get into the “mass screening” controversy and all the risks involved with treatment. In addition, we discuss our evolving understanding of cancer and the most exciting areas of research to come.

We discuss:

Ted’s unique path to get his PhD [5:15];
The exciting transition in science during Ted’s PhD in the 1990s [15:30];
Ted’s advice to MD-PhD students, and why he choose urology and Johns Hopkins [23:45];
History of prostate surgery, and Pat Walsh’s legendary work in prostate cancer [36:15];
Prostate surgery and the risks involved with treatment [53:00];
Screening for prostate cancer [58:00];
The “mass screening” controversy [1:12:45];
Biopsies and MRI: important things to know [1:25:30];
Why urology such a great field of medicine, and why Peter wants a goat [1:34:45];
Ted’s work with Ben Stiller [1:39:00];
Gleason grading system [1:43:45];
Testosterone, DHT and the prostate cancer controversy [1:53:15];
The metabolism of the prostate [2:03:00];
The most exciting areas of research in prostate cancer [2:08:00];
Benign issues involving the prostate: pelvic pain, infections and treatments [2:11:15];
Video of Ted’s surgeries, the latest technology, and males contraceptive options [2:18:00];
Watches and cars [2:23:30]; and
More.

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#38 - Francisco Gonzalez-Lima, Ph.D.: Advancing Alzheimer’s disease treatment and prevention – is AD actually a vascular and metabolic disease? Jan 28, 2019

In this episode, Francisco Gonzalez-Lima, a Professor of Neuroscience and Pharmacology & Toxicology, explains the vascular hypothesis of Alzheimer’s disease which says the central problem is a progressive neuronal energy crisis of impaired blood flow to the brain and impaired mitochondrial respiration. He walks us through the ways we can intervene in this process and also shares details of the exciting future of Alzheimer’s treatment and prevention.

We discuss:

Background and interest in the brain [5:15];
The unique nature of the human brain [9:15];
Why we’ve made so little progress in Alzheimer’s research [23:00];
The amyloid beta hypothesis [28:30];
Hypometabolism in the brain leading to cognitive decline [39:30];
Early signs of AD, and deciphering between age-related decline versus something pathologic [47:45];
The vascular hypothesis of Alzheimer’s disease [54:00];
The relationship between mitochondria, cytochrome c oxidase, and Alzheimer’s disease [1:08:00];
Chronic inhibition of cytochrome c oxidase leads to chronic neurodegenerative disease [1:22:45];
Major risk factors for AD, head trauma, and other forms of dementia [1:33:45];
Methylene blue for treating and preventing neurodegeneration [1:38:15];
Current standard of care for AD, and the reasons for a lack of advancement [2:01:45];
Near infrared light as a targeted treatment for cognitive decline [2:05:30];
The ketogenic diet as a treatment and preventative measure [2:13:15];
Exciting future research coming from Francisco [2:23:00];
Methylene blue for traumatic brain injuries [2:25:15]; and
More.

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#37 - Zubin Damania, M.D.: Revolutionizing healthcare one hilariously inspiring video at a time Jan 21, 2019

In this episode, Zubin Damania, a.k.a. Zdogg MD, a Stanford trained physician and founder of Turntable Health, discusses his evolution from disillusioned doctor suffering burnout to leading the charge for a radical shift in how we practice medicine. We also go down the rabbit hole on all sorts of juicy topics from meditation to nutrition to the nature of consciousness itself.

We discuss:

Med school antics [7:00];
Hierarchies in healthcare, physician burnout, and a broken system [20:15];
Why Zubin left medicine, and what lead to the ZdoggMD persona [31:30];
Peter’s tough decision to leave medicine [44:00];
Benefits and challenges of meditation [54:15];
Zdogg’s theory of consciousness [1:11:30];
Nutrition: Peter’s current strategy with patients [1:31:00];
The anti-vaccine dispute [1:38:15]
The common thread of all “diets”, the obesity epidemic, and Peter’s dream experiment [1:44:30];
Do we have free will? And how do we make better decisions and learn from our mistakes? [1:55:15];
Peter’s current obsessions: fasting and rapamycin, measuring autophagy, and becoming a kickass 100-year-old [2:03:15];
Reforming the healthcare payment model [2:14:45];
How to find doctors like Peter and Zubin in your area [2:28:15];
Zdogg’s amazing videos [2:31:15]; and
More.

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#36 - Eric Chehab, M.D.: Extending healthspan and preserving quality of life Jan 14, 2019

In this episode, Dr. Eric Chehab, orthopedic surgeon and sports medicine specialist, explains the measures we can take to live better and maintain our physical health through exercise and the avoidance of common injuries that prove to be the downfall for many. He also provides valuable insight for those weighing their treatment options from physical therapy to surgery to stem cells.

We discuss:

Favorite bands, musicians, and concerts [3:30];
Eric’s upbringing, biggest influences, college life, and teaching overseas [12:45];
Eric’s training, fellowship with the New York Giants, and the risk vs. reward of playing football [39:15];
The knee joint: common injuries, knee replacements, and proper exercise [1:00:00];
Best exercise for orthopedic health and bone density [1:10:00];
Most common injuries: knee, hip, shoulder, elbow, ankle, foot [1:20:45];
Physical therapy vs. surgery, and the meniscus surgery controversy [1:28:30];
PRP, stem cells, sham surgeries, and the placebo effect [1:41:00];
Back injuries: when does surgery make sense? [1:54:15];
How to find the right orthopedic surgeon for you [2:01:45];
How to cope with complications and maintain quality of life through adaptation [2:09:15];
Dr. Bukk Teef [2:26:45]; and
More.

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#35 - Nir Barzilai, M.D.: How to tame aging Jan 07, 2019

In this episode, Nir Barzilai, director of the Institute for Aging Research and expert in the genetics of longevity, discusses the evidence that metformin and rapamycin have anti-aging properties and how his TAME study aims to support this hypothesis in humans. Additionally, he describes the role of genetics in lifespan/healthspan and how it might affect important pathways such as IGF and insulin sensitivity.

We discuss:

Nir’s background and interest in aging and endocrinology [3:30];
History of metformin, and understanding the mechanism [11:15];
Attempting to define insulin resistance [21:15];
Metformin as a possible anti-aging drug [48:45];
The TAME trial: Targeting Aging with MEtformin [57:45];
Why Nir believes metformin can slow aging [1:16:30];
The genetic gift of centenarians [1:28:00];
IGF/GH and its impact on aging and chronic diseases [1:34:15];
Genetics/epigenetics of centenarians, gene sequencing, CETP-VV, Lp(a) [1:49:15];
Should you be taking HGH? [2:05:30];
NAD and NAD precursors (NR and NMN) [2:30:00];
Parting thoughts on metformin [2:36:15];
Possible blind spots in Nir and Peter’s thinking? [2:43:00]; and
More.

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#34 - Sam Harris, Ph.D.: The transformative power of mindfulness Dec 20, 2018

In this episode, Sam Harris, neuroscientist, author, and host of the Waking Up Podcast, walks us through the profound, yet practical, ways that meditation can transform our lives. Additionally, he helps to define the types of meditation and clarifies potential misconceptions with terms like happiness, pain, and suffering.

We discuss:

The transformative moment that led to Peter reaching out to Sam [3:45];
Comparing the two broad types of meditation, and Peter’s favorite meditation apps [7:45];
The pleasure of a concentrated mind, meditating with pain, and the difference between pain and suffering [13:15];
What it means to be happy, and how to break out of our default state [23:15];
The disease of distraction, why humans suffer, the limitation of happiness, and letting go of anger with mindfulness [31:00];
The challenge of learning mindfulness, the benefit of silent retreats, and Sam’s first experience in solitude as a teenager [54:15];
Sam’s life-altering experience with MDMA [1:03:00];
Mettā meditation a.k.a. loving-kindness, and the concept of ‘moral luck’ [1:14:00];
Overcoming grief and dread with meditation [1:34:45];
The wrong way to practice mindfulness, and the difference between Vipassana and Dzogchen [1:44:45];
Sam’s commitment to never lie, honesty in politics, and Sam’s viewpoint on the Trump phenomenon [2:06:00];
Teaching kids to be more mindful [2:18:30];
Sam’s current book projects, the consequences of a politically correct environment, and the potential of neuroscience to cure psychopathy [2:25:30];
How you can follow Sam’s work [2:39:00]; and
More.

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#33 - Rudy Leibel, M.D.: Finding the obesity gene and discovering leptin Dec 17, 2018

In this episode, Dr. Rudy Leibel, an expert in Clinical Molecular Genetics and Genomics at Columbia University, discusses his role in the remarkable scientific story of discovering leptin. He also gets into the genetics of obesity, as well as a broader discussion of the causes and effects of obesity, energy expenditure, and metabolism.

We discuss:

Rudy’s background, interest in obesity, and trying to understand the role and impact of adipose tissue [4:15];
Finding the first evidence of leptin by studying obese mice [23:30];
Zucker rats, and the push/pull theories of obesity [34:45];
A breakthrough in obesity research, and closing in on leptin [45:45];
Understanding leptin in humans [1:03:30];
What Prader–Willi syndrome teaches us about body weight regulation [1:09:45];
Leptin and the broad condition of obesity, metabolic consequences of weight reduction, and Peter’s self-experiments [1:18:00];
How is appetite being regulated? [1:29:45];
Are there epigenetic consequences of being obese? [1:37:00];
What makes low-carb diets so effective at obesity reduction? [1:46:15];
What did Rudy believe 10 years ago that he no longer believes to be true? [1:55:15];
Rudy’s dream study of the FTO gene [1:57:15];
What the hell does insulin resistance actually mean? [2:08:30]; and
More.

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#32 - Siddhartha Mukherjee, M.D., Ph.D.: new frontiers in cancer therapy, medicine, and the writing process Dec 10, 2018

In this episode, Siddhartha Mukherjee, oncologist, researcher, and author of the Pulitzer Prize-winning book “The Emperor of All Maladies: A Biography of Cancer,” discusses his writing process, his thoughts about medicine, cancer, immunotherapy, and his recent collaboration on a study combining a ketogenic diet with a drug in mice that provided remarkable and encouraging results.

We discuss:

Sid’s background [5:00];
How Sid and Peter met [6:00];
Sid’s Pulitzer Prize-winning book: The Emperor of All Maladies [8:00];
Sid’s writing process: the tenets of writing [12:30];
Our struggle to find preventable, human, chemical carcinogens of substantial impact [23:30];
The three laws of medicine — Law #1: A strong intuition is much more powerful than a weak test [26:30];
Law #2 of medicine: “Normals” teach us rules; “outliers” teach us laws [32:00];
Law #3 of medicine: For every perfect medical experiment, there is a perfect human bias [35:00];
The excitement around immunotherapy [38:15];
The story of Gleevec [46:00];
How does the body's metabolic state affect cancer? [49:30];
Can a nutritional state be exploited and/or a drug sensitivity be exploited through a nutritional intervention? [52:00];
How does Sid balance his family, writing, research, laboratory, and patients? [1:00:30]; and
More.

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#31 - Navdeep Chandel, Ph.D.: metabolism, mitochondria, and metformin in health and disease Dec 03, 2018

In this episode, Nav Chandel, a professor of medicine and cell and molecular biology at Northwestern University, discusses the role of mitochondria and metabolism in health and disease. Nav also provides insights into the mitochondria as signaling organelles, antioxidants, and metformin’s multifaceted effects on human health, among many topics related to well-being.

We discuss:

What got Nav interested in mitochondria [5:00];
Reactive oxygen species (ROS) [16:00];
Antioxidants: helpful or harmful? [20:00];
Mitochondria as signaling organelles [22:00];
Hydrogen peroxide (H2O2) [25:00];
Mitochondrial DNA [28:00];
Mitochondria and aging [45:00];
Metformin [52:45];
Metformin and the gut microbiome [54:00];
Metformin as complex I inhibitor and the importance of the NADH/NAD ratio [1:01:00];
Anticancer benefits of metformin [1:07:45];
Mitochondrial function is necessary for tumorigenesis [1:15:00];
Are somatic mutations the result of mitochondrial dysfunction? [1:31:30];
Vitamins and antioxidants [1:37:00];
Targeting inflammation in disease [1:43:00];
NAD precursors [1:45:45];
MitoQ [1:52:00];
Metabolite toxicity [1:56:30];
Cortisol and healthy aging [2:02:00];
Nav turns the tables and asks Peter how he deals with the “So what should I eat?” question during social encounters [2:09:00]; and
More.

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#30 - Thomas Seyfried, Ph.D.: Controversial discussion—cancer as a mitochondrial metabolic disease? Nov 26, 2018

In this episode, Thomas Seyfried, a cancer researcher and professor of biology at Boston College, discusses a controversial view of cancer as a mitochondrial metabolic disease. Many topics related to the causes, treatments, and prevention of cancer are covered in this in-depth conversation.

We discuss:

How Tom got interested in cancer research [9:00];
Calorie-restricted ketogenic diets, fasting, and epileptic seizures [18:30];
Otto Warburg and the Warburg effect [30:45];
Germline mutations, somatic mutations, and no mutations [42:00];
Mitochondrial substrate level phosphorylation: Warburg’s missing link [51:30];
What is the structural defect in the mitochondria in cancer? [1:02:00];
Peter’s near-death experience with the insulin suppression test while in ketosis [1:06:30];
Insulin potentiation therapy and glutamine inhibition [1:13:15];
The macrophage fusion-hybrid theory of metastasis [1:39:30];
How are cancer cells growth dysregulated without a mutation? [1:47:00];
What is the dream clinical trial to test the hypothesis that we can reduce the death rates of cancer by 50%? [2:03:15];
How can the hypothesis be tested rigorously that structural abnormalities in the mitochondria impair respiration and lead to compensatory fermentation? [2:26:30];
Case studies of GBM survivors [2:32:45]; and
More.

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#29 - Apolo Anton Ohno: 8-time Olympic medalist – extreme training, discipline, pursuing perfection, and responding to adversity Nov 19, 2018

In this episode, 8-time Olympic medalist, Apolo Ohno, discusses the lessons he’s learned from his remarkable career in speed skating and the extreme physical and mental training — and determination — required to reach greatness.

We discuss:

Apolo’s childhood with his single dad, early success in sports, and falling in love with skating [7:30];
The differences between inline and ice skating, and short- & long-track speed-skating, and the evolution of the clap skate [21:00];
The mental game and the physical game: intense training and mindset [29:30];
Apolo’s early success in short-track that led to an amazing opportunity and his reluctance to go for it [40:15];
Early days at Lake Placid, first experience on the world stage, and a little self-sabotage [56:45];
Tough love parenting, making a commitment, training like Rocky, and developing the mindset of a fighter [1:17:30];
2002 Olympics, winning his first medal, and rising above the sport [1:32:45];
Apolo’s evolving training and body composition throughout his Olympic career [2:05:15];
Going into the Lion’s Den to learn from Korean skaters and making a radical and risky change that led to his most successful Olympic games [2:12:45];
Apolo’s tumultuous relationship with South Korea, from hatred to respect to admiration [2:29:00];
Applying lessons learned through training, adjusting to life after skating, and the struggles many athletes face transitioning to retirement [2:46:30];
The final years of Apolo’s career: intense focus, crazy training, mental fortitude, and resiliency [2:57:30];
Officially retiring and contemplating a comeback [3:16:15];
Where does Apolo want to be in 10 years? [3:22:45];
The pursuit of perfection and flow states [3:29:30];
Where you can follow Apolo [3:35:00]; and
More.

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#28 - Mark and Chris Bell: steroids, powerlifting, addiction, diet, training, helping others, documentaries, and living your best life Nov 12, 2018

In this episode, Mark and Chris Bell discuss their love of powerlifting, their unbelievable personal records, and what prompted the making of their now iconic film, Bigger, Stronger, Faster. They also very openly discuss steroid use, their tragic family history with addiction, the many inspirations that lead to their multifaceted success, and their dedication to having a positive impact on others in fitness and life.

We discuss:

The impact of Bigger, Stronger, Faster, how it got made, and how it challenged Peter’s set of beliefs regarding steroids [4:45];
Chris’s personal story of addiction and how he’s using his experience to help others [17:30];
Importance of sharing your struggle, and the danger of comparing yourself to others [28:00];
Early life, their love of pro wrestling and what motivated Brothers Bell to be great? [33:45];
How they got started lifting weights, powerlifting vs Olympic lifting, and personal records [43:30];
Lifting weights: the importance of challenging yourself, how to avoid injury, monitoring progress, and staying motivated [1:02:30];
Chris on how changing his diet changed his performance and life [1:09:15];
Best resources for those wanting to get started lifting weights effectively and safely [1:14:00];
Teaching kids strength training early in life, the negative impact of sitting and how we can minimize it [1:18:30];
Benefits of bodybuilding, Mark’s prep for his first competition, and the role of the ketogenic diet [1:27:15];
The steroid controversy: Mark’s use of them and Peter’s perspective [1:42:15];
Testosterone: Peter’s approach to improving it in patients, and the impact of sleep, cortisol, and statins on production [1:51:00];
Upcoming nutrition documentary [2:03:00];
Parting advice from Mark [2:05:00];
Kratom, a powerful plant with the potential to help opioid addiction and more [2:06:15];
The many resources and ways to follow Mark and Chris [2:07:45]; and
More.

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#27 - David Sinclair, Ph.D.: Slowing aging – sirtuins, NAD, and the epigenetics of aging Nov 05, 2018

In this episode, David A. Sinclair, Ph.D., a Professor in the Department of Genetics at Harvard Medical School and co-Director of the Paul F. Glenn Center for the Biological Mechanisms of Aging, provides insight into why we age and how to slow its effects based on his remarkable work on the role of sirtuins and NAD in health and diseases. He also presents the case that stabilizing the epigenetic landscape may be the linchpin in counteracting aging and disease.

We discuss:

How and why David moved from Australia to Leonard Guarente’s lab at MIT [7:30];
Sirtuins and aging [15:00];
A series of experiments elucidating the mechanisms of sirtuins [20:45];
How are sirtuins activated? [25:30];
NAD and sirtuin activation [31:00];
Nicotinamide, sirtuin inhibition, andPNC1 [39:00];
Resveratrol [43:00];
The NIH/ITP studies on resveratrol [55:45];
Does David take any compounds for longevity? [1:00:15];
NAD precursors (NR, NMN) and pterostilbene [1:02:45];
Female fertility and NAD precursors [1:14:45];
A unifying theory of aging [1:20:30];
Waddington’s epigenetic landscape [1:23:00];
If David had unlimited resources, what is the experiment he would do? [1:28:25];
Testing combinations to extend lifespan [1:31:30];
What made David aware of his mortality at such a young age? [01:33:45];
What is David’s book going to cover? [01:37:15]; and
More.

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#26 - AMA #3: supplements, women’s health, patient care, and more Oct 29, 2018

In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter’s head analyst, asks the questions.

This also marks the first video release of the podcast. You can find it on YouTube (https://youtu.be/kzs7GgxR_FQ) and the website (peterattiamd.com/ama03).

If you have any questions for the next AMA, please submit them to the AMA section on the website (peterattiamd.com).

We discuss:

What references ranges does Peter consider too broad on lab tests? [5:30];
What aspect of women’s health is the least studied/understood? [21:15];
What are your thoughts on fasting and ketosis for females? [31:30];
Advice for medical students and residents, how to get through it, and optimize their time while in med school [38:00];
What is Peter’s opinion on the best way to monetize a podcast to make it sustainable? [47:45];
What are you looking to achieve and monitor with your blood glucose monitor? [57:15];
Thoughts on lithium supplementation? [1:08:15];
Insights about berberine? [1:16:00];
Why does Peter take a baby aspirin? What does the science say? [1:19:20];
How do you use HR variability as a metric in your practice and/or in your own personal use? Sleep, pre/post exercise, pre/post eating, every morning readiness? [1:23:25];
With the emergence of “the coconut oil is pure poison” article, can you shed some light on saturated fat in the literature and the types of studies done specifically on coconut oil? [1:38:45];
Would you discuss the recent meta studies that claim that moderate carbohydrate intake may be best for health? [1:40:45];
What is the number one recommendation/habit you would suggest every person add to their daily regimen (besides physical activity) for wholesome health? [1:42:45];
What does it mean if your body has a harder time getting into ketosis via fasting than it used to (testing using a Precision Xtra)? [1:44:15];
Why are you taking Zetia and Lipitor? Are you mitigating risk based on your APOE4? Or is there something else going on? [1:46:10];
What will your book be about and what is the expected release date? [1:47:45];
What are your thoughts on nicotinamide riboside supplementation for longevity? [1:49:30];
Which brand of supplements have you found to be effective? [1:54:30];
Are you currently accepting new patients? And how do I find a ‘Peter Attia clone’ in my area? [1:56:20];
Bob’s personal experience with Peter as a doctor [1:58:45];
Can you tell us more about the latest and best of APOE4? [2:06:15]; and
More.

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#25 - Scott Harrison: transformation, finding meaning, and taking on the global water crisis Oct 22, 2018

We discuss:

How Scott and Peter met [3:45];
Scott’s tragic family story that shaped his life and altered his trajectory [8:00];
High school years, rebellion, and music [30:30];
Life as a club promoter, drug use, soul-searching, and a change of heart [41:30];
Mercy Ships [1:15:00];
The amazing transformations of Mercy Ships and the parallels to his own transformation [1:28:00];
Leveraging the art of storytelling to raise money and awareness while fighting temptations to fall into his previous life [1:33:30];
Discovering the water crisis that lead to charity: water [1:46:45];
How the lack of trust in nonprofits can cripple charities [1:54:00];
The four pillars of charity: water that helped it overcome the stigma of nonprofits and become successful [2:01:00];
Where to learn more about Scott’s work and charity: water [2:12:30];
Scott’s book recommendations [2:14:30]; and
More.

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#24 - Tom Dayspring, M.D., FACP, FNLA – Part V of V: Lp(a), inflammation, oxLDL, remnants, and more Oct 19, 2018

In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. In Part V, Peter and Tom talk about inflammation, endothelial health, and oxidative stress as they pertain to cardiovascular disease, and our attempts to monitor them using biomarkers. They also discuss a couple of very important risk factors that too few people (and doctors) know about. Tom closes the five-part series with a tragic story about his good friend that is likely all-too-common for many practicing physicians, that both haunts and motivates Dr. Dayspring to learn as much as he can about the number one killer in the United States.

We discuss:

Lp(a) [2:30];
Inflammation [17:15];
Oxidative stress markers: Lp-PLA2 and oxLDL [20:45];
Endothelial health markers: ADMA and SDMA [34:30];
Remnants [43:45];
Omega-3 fatty acids (EPA and DHA) and apoC-III [55:30];
Red blood cells and cholesterol transport [1:07:45];
Tom's friend Earl [1:10:00];
Peter's friend JP [1:18:15]; and
More.

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#23 - Tom Dayspring, M.D., FACP, FNLA – Part IV of V: Statins, ezetimibe, PCSK9 inhibitors, niacin, cholesterol and the brain Oct 18, 2018

In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. In Part IV, Peter and Tom review the history and current use of drugs to prevent cardiovascular disease. They also discuss why some drugs appear to be more effective than others, an in-depth conversation about niacin, cholesterol and brain health, and the futility of using CKs (creatinine kinase) and liver function tests to identify adverse effects in statins, to name a few topics in this episode.

We discuss:

Bile acid sequestrants and statins [2:00];
Ezetimibe (Zetia) [15:00];
PCSK9 inhibitors [27:30];
Fibrates [41:00];
Fish oil, DHA, and EPA [1:01:00];
Niacin [1:05:15];
PCSK9 inhibitors [1:23:45];
Cholesterol, statins, and the brain [1:30:00];
Elevated creatine kinase (CK) and liver function tests (LFTs) on statins [1:50:30]; and
More.

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#22 - Tom Dayspring, M.D., FACP, FNLA – Part III of V: HDL, reverse cholesterol transport, CETP inhibitors, and apolipoproteins Oct 17, 2018

In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. In Part III, Peter and Tom dig into HDL, why "reverse cholesterol transport" is a lot more nuanced than what most of us are taught, lipid transport, apolipoproteins, and more. In addition, this episode highlights the complexity of HDL and a discussion about the CETP inhibitor trials.

We discuss:

Reverse cholesterol transport [1:40];
Lipid transportation, apolipoproteins, VLDL, IDL, and LDL particles [11:00];
Remnant lipoproteins and apoC-III [16:45];
Particles having sex: lipid exchange [28:00];
Cholesteryl Ester Transfer Protein (CETP) and CETP inhibitors [40:45];
2006 CETP inhibitor trial: torcetrapib (Pfizer) [54:45];
2012 CETP inhibitor trial: dalcetrapib (Hoffmann–La Roche) [56:15];
2017 CETP inhibitor trials: evacetrapib (Eli Lilly) and anacetrapib (Merck) [58:00]; and
More.

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#21 - Tom Dayspring, M.D., FACP, FNLA – Part II of V: Lipid metrics, lipid measurements, and cholesterol regulation Oct 16, 2018

In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. In Part II, Tom provides a 101 on lipids and lipoproteins. Tom and Peter also discuss the history and techniques used to measure lipoproteins, and more. We discuss:

Lipoprotein basics [1:30];
Gofman and the ultracentrifuge [5:15];
Lipoprotein structure, function, metabolism [6:45];
Lipoprotein and cholesterol measurement, and NMR technology [15:15];
LDL-C vs LDL-P and apoB [30:45];
Sterols and cholesterol synthesis [39:45]; and
More.

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#20 - Thomas Dayspring, M.D., FACP, FNLA – Part I of V: an introduction to lipidology Oct 15, 2018

In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. Part I serves as an introduction to Tom, his work, and an overview of lipid terminology.

We discuss:

Tom’s recent and remarkable physical transformation [6:30];
The moving stories behind Tom’s obsessions: firefighting, hockey, and, of course, lipids [20:30];
Tom’s medical background [39:30];
Producing some of the most accessible diagrams on lipids [50:00];
What are the different kinds of lipids, what do they do, and how are they transported? [57:15]; and
More.

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#19 - Dave Feldman: stress testing the lipid energy model Oct 08, 2018

In this episode, Dave Feldman, discusses his journey from software engineer to n=1 experimenter, his experience with low-carbohydrate diets, and his hypothesis that cholesterol levels are influenced by energy metabolism.

We discuss:

Peter’s synthesis of Dave’s energy model [5:00];
Dave’s journey from software engineer to cholesterol enthusiast [15:00];
Standard blood panels, sterol panels, and what moves the needle when it comes to particle numbers [18:30];
Hyper-responders [20:00];
Lipoprotein transport [33:45];
The lean mass hyper-responder phenotype [47:30];
The progression of atherosclerosis, CAC, and CIMT [52:30];
Testing for oxidized LDL [55:30];
All-cause mortality and clinical endpoints [1:01:15];
What does “LDL as causal” mean? [1:05:15];
Dave’s low carb cholesterol challenge and drug & genetic study qualifications [1:13:15];
If all other markers are in an healthy range, but LDL-P is high, is the patient at risk? A couple of case studies, and a self-experiment [1:27:30];
Peter’s three-day exercise and ketosis experiment [1:41:00];
What are remnant lipoproteins? [1:45:00];
What might cause lean mass hyper-responders to have higher LDL particle numbers? [1:53:30];
A case study from Dave of a lean mass hyper-responder [1:56:30];
Mass balance and cholesterol flux [2:05:30];
Can a higher degree of cholesterol explain the lean mass hyper-responder phenotype? [2:10:00];
Peter’s LDL during his keto-fast-keto experiment [2:13:30];
Does substituting saturated fats with monounsaturated fats lower LDL-P and LDL-C? [2:15:45];
Dave’s carb-swap experiments [2:22:15];
Dave’s carotid intima-media thickness tests [2:41:15];
Looking for studies that stratify for high HDL-C and low TG alongside low and high LDL-C [2:53:00]; and
More

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#18 - Richard Isaacson, M.D.: Alzheimer’s prevention Oct 01, 2018

In this episode, Richard Isaacson, a neurologist and director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine and NewYork-Presbyterian, discusses strategies for staving off Alzheimer’s disease. Richard shares a wealth of insight for people who want to know more about Alzheimer’s and what you can do to help yourself and your loved ones – starting today and continuing throughout the entire lifespan.

We discuss:

Richard’s fun-facts (and alter egos): “bling” phones, Doogie Howser, and DJ Rush [8:00];
Richard’s impetus to focus on Alzheimer’s disease: Uncle Bob [18:20];
Starting an Alzheimer’s Prevention Clinic [27:00];
How Alzheimer’s is diagnosed [30:00];
Short-term memory, processing speed, executive function and how they’re tested [35:45];
Prevention vs reduction of Alzheimer’s [44:00];
What is the prevalence of Alzheimer’s in America? [49:30];
How do people actually die from Alzheimer’s or dementia? [51:30];
How can people do everything right and still get Alzheimer’s? It’s all about AGE [55:15];
The APOE gene [58:15];
Why is the risk of Alzheimer’s higher for women? [1:13:00];
How many different paths lead to Alzheimer’s? [1:15:45];
What role does MTHFR play in Alzheimer’s? [1:19:45];
What are the “ABCs” of Alzheimer’s prevention? [1:26:45];
Baptists, Tauists, Syners, and Apostates [1:36:30];
Concerns with statin use for high-risk patients [1:45:00];
The use of Theracurmin [1:48:45];
What are the five actionable things one can do to reduce the risk for Alzheimer’s today? [1:54:30];
The cognitive reserve [2:14:15]; and
More.

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#17 - Mike Trevino: life-lessons from ultra-endurance, mindset, hard work, and removing limitations Sep 24, 2018

In this episode, ultra-endurance athlete and entrepreneur, Mike Trevino, discusses the lessons he’s learned from his remarkable athletic feats, and the training required to reach them. Not only is Mike’s advice practical for those looking to take their endurance training to the next level, but his lessons and insight are extraordinarily applicable to living everyday life.

We discuss:

Mike’s background, his crazy birthday tradition, and his transition from power to endurance [6:30];
Mike’s breakthrough year: setting a course record, and completing the Badwater 135 [16:00];
Race Across America (RAAM), perseverance, and extreme sleep deprivation [25:30];
Mindset, nutrition, fasting, and other advice from Mike for those looking to take the next step in their training [49:00];
What getting a parasite taught Mike about fasting [59:45];
The risks involved with cycling [1:03:00];
Mike setting the trans-Iowa (RAGBRAI) record [1:10:15];
PEDs, stimulants, and their effect on performance [1:15:00];
What motivates Mike (and others) to do this extreme stuff? What led him to eventually pull back? [1:22:00];
Life-lessons learned from training, and how to impart them to his kids, and others [1:35:30];
The greatest beer in the world remains a mystery [1:46:15]; and
More.

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#16 - Formula 1 (with Paul Conti): the best drivers, Ayrton Senna, and the cautionary tales of driven individuals Sep 20, 2018

In this bonus episode, Peter and med school colleague (and brilliant psychiatrist) Paul Conti reminisce on their favorite moments in Formula 1 history, their deep admiration for the late Ayrton Senna, and the remarkable careers of their all-time favorite drivers. Paul also helps to illuminate the psychological components that made the luminary drivers great, and the cautionary lessons we can take from their incredible lives.

We discuss:

Ayrton Senna [3:45];
How Senna’s death changed the sport [9:50];
The 80s & 90s: a remarkable era of Formula 1 [12:55];
Hypothesizing what caused Senna’s fatal crash [17:45];
Comparing Stewart and Senna, their incredible bravery, and what lessons we can learn from them [23:30];
Best documentaries on racing, and some of Senna’s best moments [31:00];
Gilles Villeneuve, Stefan Bellof, and some of the other greats [39:15];
Why Senna is widely acknowledged as the best of all time [46:15];
Great rivalries and personalities [49:30];
Rendezvous, a high-speed drive through Paris [56:50]; and
More.

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#15 - Paul Conti, M.D.: trauma, suicide, community, and self-compassion Sep 17, 2018

In this episode, psychiatrist Paul Conti, M.D. discusses the impact of untreated trauma, the rising rate of suicide, and the influence of modern society on mental health, to name a few important topics covered. Paul also talks about how to deal with these challenges for yourself, your loved ones, and the community at large.

We discuss:

Paul’s background, and what drove him to psychiatry [5:00];
How silent bravado and incessant striving can lead to a functional (and actual) death, and why Paul is critical of the current state of psychiatry [14:45];
Psychedelics, psychotherapy and the dissolution of the ego [20:30];
How current society may be contributing to the increasing amount of suffering [25:00];
The ubiquity and impact of untreated trauma [31:45];
The rising rate of suicide, parasuicide, and “accidental” death [35:30];
Types of trauma, why we minimize it, and Peter’s introduction to Bridge to Recovery [44:00];
Triggering shame and fear, childhood trauma, and why trauma doesn’t care about time [48:00];
The impact of the brain on the body, and overcoming trauma with self-awareness [55:00];
How to recognize and stop the cycle of shame transference [1:04:30];
Peter’s profound experience at Bridge to Recovery, and the importance of finding shared experiences with others [1:11:15];
How to identify and deal with our own personal trauma [1:19:00];
Finding meaning in struggle, why we are less happy than ever, and the impact of an isolated society [1:25:30];
What steps can we take as a society to make an appreciable impact on the rising sense of desperation and misery? [1:43:15];
Resources, book recommendations, and things you can do [1:56:15]; and
More.

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#14 - Robert Lustig, M.D., M.S.L.: fructose, processed food, NAFLD, and changing the food system Sep 10, 2018

In this episode, Rob Lustig — a researcher, an expert in fructose metabolism, and a former pediatric endocrinologist — discusses what’s wrong with the current food environment, and what we can do to reduce our chances of becoming part of the obesity, diabetes, metabolic syndrome, and nonalcoholic fatty liver disease (NAFLD) epidemics. Rob recently earned a Master of Studies in Law because he believes that educating people about sugar from a scientific standpoint is only half the equation: the other half involves changing policy, which he explains in this episode.

We discuss:

What’s the difference between glucose and fructose? [7:00];
Do we have biomarkers that can give us some indication of average exposure to fructose over a given period of time? [14:20];
What’s the difference between ALT and AST? [18:45];
Inflammation, endothelial function, and uric acid [21:30];
Is there something that fructose does better than glucose? [23:45];
For children that undergo a remarkable shift from metabolic health to metabolic derangement, is there a concern that these kids suffer an epigenetic hit that makes it harder for them later in life? [26:15];
How many times do you have to introduce a savory food vs a sugary food to an infant before they will accept it? [29:30];
How are alcohol and fructose similar in how they affect the brain? [33:51];
Advice for parents and kids for creating a sustainable environment that's going to prevent them from running into metabolic problems [40:30];
Why do some populations have a higher risk for NAFLD? [45:42];
What causes NAFLD? [48:45];
Is insulin resistance the result of NAFLD or is NAFLD the result of insulin resistance? [56:00];
HRV, cortisol, and norepinephrine [1:00:30];
What are the actual mechanisms that links metabolic syndrome, insulin resistance, fatty liver, and type 2 diabetes? [1:03:00];
Is the food industry still saying that all calories contribute equally to adiposity and insulin resistance? [1:09:00];
What is the difference between soluble and insoluble fiber and why do you need both? [1:13:00];
How can we change the food system when 10 companies control almost 90 percent of the Calories we consume in the US? [1:15:00]; and
More.

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#13 - Brett Kotlus, M.D.: How to look younger while you live longer Sep 03, 2018

This episode explores the question of how we can maintain a naturally youthful look as we get older. Brett — a New York City oculofacial plastic surgeon who specializes in both non-surgical and surgical cosmetic and reconstructive procedures of the eyes and face — shares some remarkably practical advice on everything from the most extensive procedural options, down to the simple steps one can do themselves, starting today, that can make a tremendous impact. Brett also discusses how to pick a provider you trust while you’re sorting through the ever-growing list of facial treatments and cosmetic procedures.

We discuss:

History of medical training that led to Brett’s current interests [5:00];
What changes occur that make skin look older over time? [8:00];
How to avoid the “unnatural” look associated with cosmetic surgery [17:00];
Facial augmentation, fixing eye-bags, and picking the right provider [22:15];
Common botox mistakes, and how to do it right [37:30];
Protect and rejuvenate your skin with these 3 main tools [46:30];
Latest trends in cosmetic industry, botox, cryolipolysis, the various forms of facials, and PRP [1:05:00];
Importance of picking a provider you trust, rather than a device you want [1:31:30];
Future of the cosmetic field [1:33:00]; and
More.

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#12 - Corey McCarthy: Overcoming trauma, dealing with shame, finding meaning, changing the self-narrative, redemption, and the importance of gratitude Aug 27, 2018

Corey and Peter met when they visited North Kern State Prison in California together as volunteers for Defy Ventures. Peter was moved by Corey’s remarkable story, who is a former inmate himself, and realized he had to have him on the podcast to share his experiences with a wider audience. You’ll almost assuredly take away something very important from listening to this episode. Understanding how your experiences can define you, what forgiveness means of both yourself and others, and how good people can do bad things, are just a few of the takeaways.

We discuss:

How Corey and Peter met through Defy Ventures [4:00];
How Corey’s prison experience has shaped his life story [13:30];
Corey’s early life, and the traumatic event that changed everything [16:00];
Early adolescence years, beginnings of addiction, and overwhelming shame [23:00];
The 5 ways to classify wounds, and the relationship between trauma and addiction [39:00];
Turbulent high school years, the struggle of parenting a troubled child, and more trauma further shaping the self-narrative [46:00];
Post high school years, spiraling out of control, and giving up on himself [1:02:00];
Navigating prison life, and why a desire to change often isn’t enough to make it happen [1:19:00];
The turning point and eventual road to recovery [1:48:00];
12 step programs: Pros and Cons [1:54:00];
Final days in prison, getting released, and routines Corey has kept [1:54:00]
Corey’s new perspective on life, takeaways from the visit to Kern prison [2:12:30]; and
More.

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#11 - AMA #2: the Nothingburger — results from Peter’s week-long fast between two weeks of nutritional ketosis — and answering questions on all things fasting Aug 23, 2018

Consider this episode a cross between an ask me anything (AMA) and a show-and-tell. Peter discusses his fasting experiment in great detail and answers questions from listeners and readers.

We discuss:

Why Peter did a one-week fast and the rationale for front- and back-ending it with a week-long ketogenic diet [6:30];
What Peter’s typical diet, exercise, sleep, stress management, and supplementation looks like [11:00];
What labs (e.g., glucose, ketones, lipids, inflammation and oxidation markers, thyroid- and sex hormones) Peter checked for the experiment [22:00];
Peter’s results after a week on a ketogenic diet [29:30];
Peter’s results after a week on a water-only fast [48:45];
Peter’s results after a week on a ketogenic diet following a week of fasting [58:30];
Peter’s “Top 6” surprises from the fasting experiment [1:08:30];
Different fasting-mimicking diet (FMD) protocols [1:29:20];
What is the optimal protocol, frequency, and duration for fasting? [1:33:00];
How to break a fast without GI distress? [1:38:00];
“Am I breaking the fast if…?” [1:41:30]; and
More.

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#10 - Matt Kaeberlein, Ph.D.: rapamycin and dogs — man’s best friends? — living longer, healthier lives and turning back the clock on aging, and age-related diseases Aug 20, 2018

Matt is someone who is deeply interested in understanding the biology of aging. Why do we age? What happens to us as we age? What are the things we can do to slow the aging process? How can we delay or prevent the onset of age-related diseases? These are all questions that Matt thinks deeply about, and explores these questions with his research at the University of Washington. He is currently investigating many of these questions through the Dog Aging Project and the compound rapamycin—the only known pharmacological agent to extend lifespan all the way from yeast to mammals—across a billion years of evolution. We talk about cancer, heart disease, Alzheimer’s disease, healthspan, lifespan, and what we can do to provide longer, healthier lives for both people and dogs.

We discuss:

Matt’s early years and his a-ha moment on aging [4:00];
Studying dogs [6:30];
Dogs, rapamycin, and its effects on lifespan and healthspan [15:30];
An unexpected finding in presumably healthy dogs [36:00];
Rapamycin in cancer treatment [50:00];
Why isn’t there a rapamycin trial for Alzheimer’s disease (AD)? [1:01:30];
If Matt could do a definitive study on life extension in dogs, with resources not being a concern, what does that experiment look like? [1:16:00]; and
More.

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#09 - David Sabatini, M.D., Ph.D.: rapamycin and the discovery of mTOR — the nexus of aging and longevity? Aug 13, 2018

In this episode, my good friend David Sabatini delves into his extensive work with the mechanistic target of rapamycin—better known as mTOR—and rapamycin. The compound rapamycin is the only known pharmacological agent to extend lifespan all the way from yeast to mammals—across a billion years of evolution. David, a professor of biology and a member of the Whitehead Institute at MIT, shares his remarkable journey and discovery of mTOR in mammalian cells and its central role in nutrient sensing and longevity. Fasting, rapamycin, mTOR, autophagy, gedankenexperiments: having this conversation with David is like being the proverbial kid in the world’s greatest candy store.

We discuss:

mTOR and David’s student years [4:30];
Rapamycin and the discovery of mTOR [8:15];
The connection between rapamycin, mTOR, and longevity [30:30];
mTOR as the cell’s general contractor [34:45];
The effect of glucose, insulin, and amino acids on mTORC1 [42:50];
Methionine sensing and restriction [49:45];
An intermittent approach to rapamycin [54:30];
Rapamycin’s effects on cancer, cardiovascular disease, and neurodegeneration [57:00];
Gedankenexperiment: couch potatoes on rapamycin vs perfectly behaved humans [1:03:15];
David’s dream experiment with no resource constraints [1:07:00]; and
More.

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#08 - Tom Bilyeu: nutrition, fasting, meditation, mindset, immortality, and the secret formula of fulfillment Aug 06, 2018

Tom Bilyeu is the founder of Impact Theory and a co-founder of Quest Nutrition. In this episode, among the highlights, Tom provides powerful insight he’s gained through his pursuit of fulfillment which led to a billion-dollar company in Quest Nutrition. Tom makes a compelling case that it starts with a growth mindset and he’s determined to impart this knowledge into as many people as possible.

We discuss:

Tom’s history with dieting and his changing views on fat [4:00];
Tom’s dream of immortality [10:00];
Life leading to Quest Nutrition and how “mindset” made the difference [18:45];
Why Tom helped start Quest Nutrition and what made it a success [27:00];
Why Tom started Impact Theory [35:00];
Money and motivation [44:00];
What Tom learned interviewing every employee at Quest, and the one question everyone answers exactly the same [54:15];
Tom’s secret formula of fulfillment and the ubiquity of suicide [1:00:00];
Nutrition, fasting, sleep, meditation, and other routines Tom uses to function at his best [1:13:15]; and
More

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#07 - Deep Dive: Lp(a) — what every doctor, and the 10-20% of the population at risk, needs to know Jul 30, 2018

Pronounced, el-pee-little-a, this lipoprotein is simply described as a low density lipoprotein (LDL) that has an apoprotein “a” attached to it...but Lp(a) goes far beyond its description in terms of its structure, function, and the role that it plays in cardiovascular health and disease. Affecting about 1-in-5 people, and not on the radar of many doctors, this is a deep dive into a very important subject for people to understand.

A quick primer on lipoproteins [7:30];
Intro to Lp(a) [11:00];
Lab tests for Lp(a) and reference ranges [20:00];
The physiologic functions of Lp(a) [31:00];
The problems associated with high Lp(a) [34:15];
Lipid-lowering therapies of Lp(a) [44:45];
Lp(a) modification through lifestyle intervention [1:00:45];
High LDL-P on a ketogenic/low-carb-high-fat diet [1:05:30]; and
More

Learn more at www.PeterAttiaMD.com

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#06 - D.A. Wallach: music, medicine, cancer screening, and disruptive technologies Jul 23, 2018

D.A. Wallach is a true polymath: recording artist, songwriter, essayist, investor, and so much more. In this episode, among the highlights, D.A. provides compelling and colorful insight into how the music industry works today vs the past, liquid biopsies, how to approach healthspan, cancer screening, and how we can reach a “singularity” in medicine.

We discuss:

How to learn music as a kid and an adult [7:30];
Chester French’s early struggles and ultimate success [16:45];
Learning to learn, fostering curiosity in kids, and balancing creativity with structure [31:30];
D.A.’s musical inspirations [44:30];
History of the music industry, Spotify, and other disruptive technologies [50:00];
The past, present, and future of medicine, hospitals, and healthcare [1:05:30];
Investing in health [1:16:30];
What D.A. is most excited about in the future of medicine [1:22:00];
Liquid biopsies, how to make sense of the morass of sensitivity, specificity, positive predictive value, negative predictive value, true negatives, false positives, false negatives, and true positives in cancer screening...and the swiss cheese metaphor [1:33:00];
The immune system, inflammation, and allergies [2:05:45]; and
More.

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#05 - Dom D’Agostino, Ph.D.: ketosis, n=1, exogenous ketones, HBOT, seizures, and cancer Jul 16, 2018

Dom digs deep into the research and application of ketogenic diets, exogenous ketones, hyperbaric oxygen treatment, and treating cancer with a metabolic approach. Plus, we lost track of the number of n=Dom experiments mentioned in this episode.

We discuss:

Dom’s early medical training in hyperbaric chambers [7:00];
Effect of ketones on cancer cells [20:00];
Ketones and oxygen toxicity seizures [32:00];
HBOT & its many applications [40:00];
Ketones, MCTs, and exogenous ketones [59:15];
How ketones affect blood glucose [1:20:00];
Ketone esters, salts, enantiomers vs. racemic BOHB [1:38:00];
Dom’s ketone tolerance test [1:56:00];
The metabolic management of cancer with a Press-Pulse approach [1:59:45]; and
More.

Learn more at www.PeterAttiaMD.com

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#04 - AMA #1: alcohol, best lab tests, wearables, finding the right doc, racing, and more Jul 09, 2018

In his first “Ask Me Anything” episode, Peter answered your questions submitted to him via Twitter.

We discuss:

What are Peter’s thoughts on alcohol consumption and health? [4:00]
What are the best lab tests to request from your PCP, and what are the best markers for longevity? [14:00]
What are the best wearables and why, and why does Peter use a continuous glucose monitor? [35:00]
How does one select the right physician as a patient? [47:00]
Why does Peter race cars and what’s the hardest thing to learn as a new driver? [54:30]
What is Peter’s current exercise regimen and what are his thoughts on exercise for improving lifespan and healthspan? [1:20:15]
What is Peter’s strategy for learning something deeply? [1:33:00]
What is Peter’s process for forming his beliefs? [1:53:30]
What does Peter’s diet look like these days? [1:57:45]
And more.

Learn more at www.PeterAttiaMD.com

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#03 - Ron Krauss, M.D.: a deep dive into heart disease Jul 02, 2018

Whenever I’m stumped on a patient case or in my thinking about lipids, Ron is one of the first people I turn to for insight. Ron is recognized globally for his research into lipidology and has worn many hats in his career, including clinician, lipidologist, nutrition, genetics, and drug research.

In this episode, we explore heart disease at its origins before diving into the highly discussed, largely misunderstood, role of LDL and inflammation in atherosclerosis. Ron also shares his insights on the evidence for and against statins and other lipid-lowering therapies. My hope is that both the curious patient and the physician can get a lot out of this episode by being more informed about dyslipidemia and the interventions used to reduce the risk of atherosclerotic disease. We covered a lot of ground on this critically important topic.

We discuss:

The pathogenesis of atherosclerosis [7:00];
How early atherosclerosis begins [12:40];
Ron’s motivation for getting into lipidology [43:00];
How reading an article series in the NEJM in 1967 had a profound impact on him and his career [43:30];
How PCSK9 inhibitors work and why they may be under-utilized [47:00];
Mendelian randomization: nature’s randomized trial [49:15];
The “battle” between particle size and particle number [52:00];
The use of statins [1:04:45];
The role of chronic inflammation in atherosclerosis [1:24:15];
Why niacin may have been unjustly dismissed as a therapeutic option [1:40:45];
The HDL paradox: why drugs that raise HDL-C seem to raise (or have little impact on) heart disease risk [1:43:00];
Lp(a) [1:47:45];
And more.

Learn more at www.PeterAttiaMD.com

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#02 - Rhonda Patrick, Ph.D.: the performance and longevity paradox of IGF-1, ketogenic diets and genetics, the health benefits of sauna, NAD+, and more Jul 02, 2018

Rhonda and I go on a Nerd Safari into the jungle of health, nutrition, fitness, performance, and longevity. We visit IGF-1 and whether there’s a tradeoff of having high or low levels. We discuss the PPARs (receptor proteins) and genetic polymorphisms. Does Rhonda think there’s any benefit in a NAD+ booster for health and longevity? Can saunas lower the risk of heart disease, dementia, and all-cause mortality?

Rhonda is a wealth of knowledge on so many topics and was the perfect companion to dig into so many fun topics in this episode. She puts a ton of thought into her research and it really shows in this conversation.

We discuss:

What Rhonda believes differently today than she did a few years ago [5:40];
The paradox of GH/IGF-1 in performance and longevity [21:00];
The role of PPAR in fat metabolism and ketogenic diets [23:00];
The possible genetic explanations for why some patients don’t respond well to a ketogenic diet [31:00];
The health benefits of heat and cold exposure [1:12:30];
NAD+ [1:32:45];
And more.

Learn more at www.PeterAttiaMD.com

Connect with Peter on Facebook | Twitter | Instagram

#01 - Tim Ferriss: depression, psychedelics, and emotional resilience Jul 02, 2018

Excited to kick off the podcast with special guest and close friend Tim Ferriss, lifehacker, podcaster extraordinaire, and author of multiple best-selling books that includes The 4-Hour Workweek, The 4-Hour Body, Tools of Titans, and Tribe of Mentors.

In this podcast we cover mental health, depression, and our mutual interest in psychedelics as potential therapeutic agents. Tim talks both experientially and from his own deep dive into the literature of psychedelics and mental health. Tim is shifting his focus from investing in startups to funding experiments that he hopes will establish more reliable knowledge and therapeutic options for those suffering from anxiety, depression, and addiction.

Tim also shared his list of acquired wisdom he returns to most reliably, which might be worth the price of admission alone.

We discuss:

Tim’s history of depression and his TED Talk on his close call with suicide [11:15];
The type of thinking that triggers Tim’s downward spirals [17:15];
Tim’s transformative experience with ayahuasca [48:45];
How Tim’s experience and research has led him to focus on furthering the science on psychedelics and mental health [53:00];
What some of the meditation modalities, and meditation apps, are out there, why meditation can be so hard to do, but also worthwhile to stick with [1:13:00];
Why Tim made a big commitment (more than $1 million) to funding scientific research, and to psilocybin and MDMA research, in particular [1:31:00];
From all the habits and tools that Tim has learned, the five things that he returns to most reliably [2:33:00];
And more.

Learn more at www.PeterAttiaMD.com

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#00 - Sneak Peek: The Peter Attia Drive Jun 19, 2018

Welcome to a special sneak peek of The Peter Attia Drive. The Peter Attia Drive will feature guests and experts that will offer advice and insight to help you optimize performance, health, longevity, critical thinking, and life. It’s hosted by Stanford M.D., TED speaker, and longevity expert Dr. Peter Attia, founder of Attia Medical, PC, a medical practice with offices in San Diego and New York City.

Learn more at www.PeterAttiaMD.com

Connect with Peter on Facebook | Twitter | Instagram.

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