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The Peter Attia Drive

ByPeter Attia, MD
397 episodes

Podcast Summary

Dive into "The Peter Attia Drive," where health meets high performance in a thought-provoking exploration of longevity and optimal living. Hosted by Dr. Peter Attia, a physician with an impressive background from Stanford, Johns Hopkins, and the NIH, this podcast stands out for its deep, nuanced conversations with leading experts across diverse fields. Listeners can expect to hear from renowned guests, including Dr. Andrew Huberman, who shares insights on neuroscience and behavior, and Dr. Mark Hyman, who delves into the intersection of nutrition and health. Each episode rigorously examines topics like metabolic health, the nuances of aging, and the science behind peak physical performance, challenging conventional wisdom and encouraging critical thinking. Whether you’re a health enthusiast or simply curious about optimizing your life, "The Peter Attia Drive" promises to inspire and inform, making it a must-listen for anyone committed to excellence and well-being.

#1

#351 ‒ Male fertility: optimizing reproductive health, diagnosing and treating infertility, and navigating testosterone replacement therapy | Paul Turek, M.D.

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useThis is part one of a two-part mini-series on fertility and reproductive health, with next week's guest, Dr. Paula Amato, focusing on the female side of the equation. Paul Turek is a world-renowned expert in male fertility and reproductive health, the founder and medical director of the Turek Clinic, and host of the Talk with Turek podcast. In this episode, Paul explores the topic of male fertility, offering a detailed look at the complex and highly coordinated process of conception and the many challenges sperm face on their journey to fertilizing an egg. He shares fascinating insights into how sperm work together to navigate the female reproductive tract, how environmental factors like heat, stress, and toxins impact sperm quality, and what men can do to improve their reproductive health. Paul also dispels common myths about testosterone replacement therapy and its effects on fertility, providing strategies for preserving fertility while on TRT. The episode also highlights cutting-edge advances in reproductive medicine, from genetic testing and sperm sorting to emerging treatments for infertility.We discuss:0:00:00 - Intro0:01:12 - The incredibly complex and hostile journey sperm must take to fertilize an egg0:08:15 - How sperm are made: meiosis, genetic variation, and the continuous renewal influenced by environmental factors0:14:53 - The built-in filter that weeds out genetically abnormal sperm0:18:57 - How sperm are finalized in form and function: tail formation, energy storage, and chemical sensing abilities0:28:33 - How to optimize conception through the timing of sex, ejaculation frequency, and understanding the sperm lifecycle0:37:03 - Male infertility and Paul’s diagnostic approach: detailed history, a physical exam, and identifying red flags0:44:43 - Viral infections that can affect the testes and po...

2025-06-02•2hr 40mins
#2

#350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useKyler Brown is a sports rehab chiropractor who specializes in injury recovery, pre- and post-surgical rehabilitation, and guiding clients from rehab back to peak performance. As co-founder of the private training program 10 Squared alongside Peter, Kyler shares his approach to injury prevention and performance optimization—highlighting how overlooked movement patterns can quietly lead to chronic issues over time. He outlines a practical framework for assessing and treating individuals, highlights the importance of understanding movement dynamics and asymmetries, and discusses personalized rehab strategies through real-world case studies. The conversation also explores the psychological side of recovery, including the role of fear and mental barriers in rehabilitation. Kyler shares actionable tools to evaluate movement patterns and implement training strategies that support long-term strength and health.A companion video series demonstrating exercises for common problem areas—such as the lower back, neck, shoulders, and knees—is available exclusively to subscribers on the show notes page.We discuss:0:00:00 - Intro0:01:37 - The personalized rehab strategy for Peter’s shoulder surgery that sparked creation of a training program called 10 Squared0:10:42 - Training for the marginal decade: why precision and purpose are essential for quality of life0:18:20 - The Centenarian Decathlon: how training for long-term capacity enhances both current and future quality of life0:24:59 - How the shortcomings of conventional rehab and performance systems led to the creation of 10 Squared, a personalized training model focused on long-term physical capacity and individualized care0:33:07 - Case study: how personalized assessment and treatment at 10 Squared helps uncover the root causes of injuries0:43:19 - The role of the “core” ...

2025-05-26•1hr 53mins
#3

#349 - AMA #71: Building strength and muscle mass: how to optimize training, nutrition, and more for longevity

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useIn this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of muscle mass and strength, examining their essential roles in both lifespan and healthspan. Drawing from over 30 hours of prior discussions with experts including Layne Norton, Andy Galpin, and Mike Israetel, this episode distills the most important insights into one comprehensive and up-to-date conversation. Peter explores why muscle matters for longevity, metabolic health, and injury prevention, and clarifies the differences between muscle mass and strength, including which is more vital for aging well. He breaks down practical strategies for building muscle safely and effectively, including progressive overload, training intensity, rep ranges, and the importance of explosive power. Peter also covers key nutrition strategies—like protein intake, timing, and creatine supplementation—and offers practical advice for everyone from beginners to seasoned lifters on building and maintaining muscle safely and sustainably.We discuss:01:08 - Peter’s humorous experience talking nutrition with a second grader05:10 - Overview of topics, episode structure, and reasoning for focus on muscle mass and strengthIn the full episode, we also discuss:Defining key terms: muscle mass, strength, hypertrophy, power, and moreThe importance of muscular strength, muscle mass, and cardiorespiratory fitness for longevityGrip strength as a simple yet powerful predictor of all-cause mortalityIs muscle strength causal or just a marker of health?Why VO2 max, strength, and muscle mass are powerful health markers: a reflection of long-term consistent effortHow muscle mass and strength enhance healthspan by supporting metabolic health, inflammation control, recovery from illness, mobility, and fall preventionHow muscle mass and strength decline with age, and why it's essen...

2025-05-19•10mins
#4

#348 ‒ Women’s sexual health, menopause, and hormone replacement therapy (HRT) | Rachel Rubin, M.D.

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useRachel Rubin is a board-certified urologist and one of the nation's foremost experts in sexual health. In this episode, she shares her deep expertise on the often-overlooked topic of women’s sexual health, exploring why this area remains so neglected in traditional medicine and highlighting the critical differences in how men and women experience hormonal decline with age. Rachel explains the physiology of the menstrual cycle, the complex hormonal shifts of perimenopause, and the wide-reaching health risks associated with menopause, including osteoporosis, cardiovascular disease, dementia, and recurrent urinary tract infections. She also breaks down the controversy surrounding hormone replacement therapy (HRT), particularly the damaging legacy of the Women’s Health Initiative study, and provides guidance on the safe and personalized use of estrogen, progesterone, and testosterone in women. With particular emphasis on local vaginal hormone therapy—a safe, effective, and underused treatment—Rachel offers insights that have the potential to transform quality of life for countless women.We discuss:0:00:00 - Intro0:01:56 - Rachel’s training in urology and passion for sexual medicine and women’s health0:04:55 - Hormonal changes during ovulation, perimenopause, and menopause: why they occur and how they impact women’s health and quality of life0:14:34 - Why women have such varied responses to the sharp drop in progesterone during the luteal phase and after menopause, and the differing responses to progesterone supplementation0:17:55 - The physical and cognitive health risks for postmenopausal women who are not on hormone therapy0:20:37 - The history of hormone replacement therapy (HRT), and how misinterpretation of the Women’s Health Initiative study led to abandonment of HRT0:30:59 - The medical system’s failure to t...

2025-05-12•2hr 27mins
#5

#347 – Peter’s takeaways on sleep, chronic pain, cancer drugs, healthcare with AI, radiation therapy, and trauma | Quarterly Podcast Summary #5

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useIn 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 his discussions with Jeff English on the journey to healing from trauma; Ashley Mason on improving sleep and CBT-I; Sanjay Mehta on misconceptions around radiation and its use in cancer therapy and treating inflammatory conditions (such as arthritis and tendonitis); Sean Mackey on understanding and treating acute and chronic pain; and Susan Desmond-Hellmann on insights from her extraordinary career that pertain to the use of AI in medicine, understanding cancer, and the development of cancer therapeutics. Additionally, Peter shares any behavioral changes he’s made for himself or his patients as a result of these fascinating discussions.We discuss:00:00 - Intro01:35 - Summary of episode topics03:39 - Jeff English episode: how trauma shapes behavior and identity, and the value of understanding personal adaptations and working through unresolved emotional wounds15:12 - Practical behavioral changes and emotional tools Peter has applied since the Jeff English episode22:50 - Ashley Mason episode: treating insomnia using CBT-I and practical behavioral techniques for improving sleep qualityIn the full episode, we also discuss:When to seek professional care for sleep issuesSanjay Mehta episode: radiation therapy’s evolution, its underused potential in treating inflammatory conditions, and the cultural misconceptions surrounding radiation exposurePeter’s predictions and insights for the upcoming Formula 1 seasonSean Mackey episode: the neuroscience, classifications, and treatment strategies for chronic pain, and the importance of personalized careSusan Desmond-Hellmann episode: how AI is revolutionizing medicine through advancements in drug d...

2025-05-05•37mins
#6

#346 - Scaling biotech and improving global health: lessons from an extraordinary career in medicine | Susan Desmond-Hellmann, M.D., M.P.H.

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useSusan Desmond-Hellmann is a physician and scientist whose remarkable career has spanned clinical medicine, oncology, biotech innovation, and global health leadership. In this episode, Susan shares insights from her journey training in internal medicine during the early AIDS crisis, treating HIV-related cancers in Uganda, and developing groundbreaking cancer therapies like Herceptin and Avastin. She reflects on her leadership roles at UCSF and the Bill and Melinda Gates Foundation, offering lessons on guiding large-scale health initiatives, navigating uncertainty, and fostering scientific innovation. The conversation explores the promise of precision medicine, the integration of patient care and policy, and the evolving role of artificial intelligence in transforming diagnostics, drug development, and global access to care.We discuss:0:00:00 - Intro0:01:37 - Susan’s medical training, the start of the AIDS epidemic, and the transformative experiences that shaped her career0:12:56 - Susan’s experience working on the frontlines of the HIV/AIDS crisis in Uganda0:29:54 - Susan’s time working in general oncology and her transition to biotech where she helped develop taxol—a top-selling cancer drug0:41:21 - Genentech’s origins, and its groundbreaking use of recombinant DNA to develop biologic drugs0:51:03 - Susan’s move to Genentech, and her pivotal role in the development and success of Herceptin as a groundbreaking therapy in targeted oncology1:00:57 - The rise of antibody-based cancer therapies: the development of Rituxan and Avastin1:12:12 - The step-by-step drug development process and the scientific and strategic challenges involved1:24:40 - The ethical and economic controversy surrounding Avastin’s high cost and limited survival benefit1:27:22 - Susan’s tenure as chancellor at UCSF: leading during a financially ...

2025-04-28•2hr 31mins
#7

#345 ‒ Chronic pain: pathways, treatment, and the path to physical and psychological recovery | Sean Mackey, M.D., Ph.D.

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useSean Mackey is a professor of pain medicine at Stanford University and the director of the Stanford Systems Neuroscience and Pain Lab, where his research explores the neural mechanisms of pain and the development of novel treatments for chronic pain. In this episode, Sean joins Peter for a wide-ranging discussion on the multifaceted nature of pain—as both a sensory and emotional experience—and its evolutionary purpose as a critical survival mechanism. He dives into how pain is transmitted through the nervous system, the different types of pain, and why different individuals perceive pain so differently. Sean shares insights into pain management strategies ranging from medications like NSAIDs and opioids to neuromodulation techniques such as transcutaneous electrical nerve stimulation (TENS). Additionally, this episode explores the interplay between sleep and chronic pain and the psychological and emotional dimensions of pain, and it includes a personal story from Peter about his own experience with pain and how Sean’s expertise helped him more than two decades ago.We discuss:0:00:00 - Intro0:01:34 - The definition of pain, and how our understanding of pain has evolved from a simplistic body-mind separation to a nuanced biopsychosocial model0:09:42 - The biological mechanisms behind how we perceive pain0:15:15 - The role of consciousness in the perception of pain, and how nociception functions during unconscious states0:24:02 - The four types of pain0:35:17 - Using fMRI to identify objective biomarkers of pain in the brain0:40:38 - The evolutionary role of pain in human behavior and survival0:46:52 - How the brain processes and modulates pain signals, Gate Control Theory, the variability in individuals’ pain perception, and effectiveness of neuromodulation techniques like TENS1:01:36 - The brain’s influence on p...

2025-04-21•3hr 18mins
#8

#344 - AMA #70: Nicotine: impact on cognitive function, performance, and mood, health risks, delivery modalities, and smoking cessation strategies

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useIn this “Ask Me Anything” (AMA) episode, Peter dives deep into nicotine—a topic increasingly debated both scientifically and publicly. He clarifies the critical differences between nicotine and tobacco, highlighting why nicotine alone isn't primarily responsible for smoking's severe health consequences. Peter examines the specific risks associated with nicotine use, including addiction, sleep disruption, cardiovascular concerns, and effects on mood and anxiety. He evaluates various nicotine delivery methods, from traditional cigarettes to gums, pouches, and synthetic alternatives, ranking them according to their relative safety. Additionally, Peter explores nicotine's potential positive and negative impacts on physical performance, cognitive function, fertility, and its interactions with other stimulants like caffeine. Finally, he provides practical guidance for minimizing risks with nicotine use and offers thoughtful strategies for smoking cessation and effective nicotine replacement therapies.We discuss:01:38 - Revisiting the previous AMA on microplastics: low-effort, high-impact changes to significantly reduce microplastic exposure03:40 - Overview of episode topics related to nicotine05:06 - The current landscape of nicotine research07:18 - Addressing the common misconception that nicotine itself is the primary cause of tobacco-related health risks11:12 - Peter’s Marlboro-branded apparel is a nostalgic tribute to the Formula One era and not a sign of support for smoking13:50 - The limitations of current research on the health risks of nicotine itself20:36 - The most common side effects of nicotineIn the full episode, we also discuss:The impact of nicotine on sleepNicotine and mood: how nicotine can have both anxiety-inducing and calming effects based on genetics and dosageThe addictive properties of nicotine...

2025-04-14•23mins

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#9

#343 – The evolving role of radiation: advancements in cancer treatment, emerging low-dose treatments for arthritis, tendonitis, and injuries, and addressing misconceptions | Sanjay Mehta, M.D.

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useSanjay Mehta is a radiation oncologist with over 25 years of experience, and is currently the president of Century Cancer Centers in Houston, Texas (drsanjaymehta.com). In this episode, Sanjay explores the rapidly evolving field of radiation oncology, addressing common misconceptions about radiation exposure. He delves into radiation’s critical role in modern oncology, examining recent advancements that precisely target tumors while minimizing damage to surrounding healthy tissues and reducing side effects, with specific insights into breast, prostate, and brain cancers. Sanjay discusses fascinating international practices involving low-dose radiation therapy for inflammatory conditions such as arthritis, tendonitis, and sports injuries, highlighting its effectiveness and potential for wider adoption in the United States. Wrapping up on a lighter note, Peter and Sanjay discuss their mutual passion for cars and reveal how this shared interest first brought them together.We discuss:0:00:00 - Intro0:01:34 - How radiation oncology became a distinct, rapidly evolving medical specialty0:04:47 - Defining radiation, ionizing vs. non-ionizing, and common misconceptions about radiation exposure0:08:48 - How radiation doses are measured, real-world examples of radiation exposure, and safety practices0:14:28 - Radiation doses from common medical imaging tests, and why benefits of routine imaging outweigh risks0:25:10 - Therapeutic radiation oncology: the evolution of breast cancer treatment toward less invasive surgery combined with targeted radiation0:29:11 - Modern radiation oncology treatments for breast cancer—minimizing risks and maximizing patient comfort and outcomes0:42:47 - How advances in radiation dosing, technology, and treatment precision have significantly reduced side effects0:48:01 - How breast implants aff...

2025-04-07•2hr 27mins
#10

#342 ‒ Aging well: Peter shares strategies for improving longevity with residents at a senior living center

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useIn this special episode of The Drive, Peter joins a unique conversation inspired by his daughter’s volunteer experience at a senior care center, where she formed meaningful relationships with residents curious about healthspan, lifespan, and strategies for living well as they age. Peter engages directly with the residents, covering critical topics like the profound impact of exercise—particularly strength training— for maintaining mobility, preventing falls, and preserving independence later in life. He also discusses the importance of nutrition, emphasizing adequate protein intake, along with strategies for sleep optimization and preservation of brain health. Peter also underscores the importance of emotional wellness, purpose, and social connections in healthy aging, provides advice on staving off chronic disease, and much more.We discuss:0:00:00 - Intro0:01:10 - Peter’s definition of longevity0:04:33 - Why it’s never too late to invest in your longevity0:06:51 - The importance of adding “life to years” rather than just “years to life”0:08:32 - The "four horsemen"—heart disease, cancer, neurodegenerative diseases, and metabolic conditions0:10:58 - Advice for those managing chronic diseases later in life0:13:15 - Why balance declines and falls become increasingly common with age, and how to prevent them0:18:38 - Why strength training is essential (and effective) for older adults0:21:20 - The five tools in Peter’s longevity toolkit0:22:41 - Practical ways older adults can safely begin exercising despite physical limitations or health issues0:24:43 - Principles of good nutrition, and the importance of adequate protein intake0:28:27 - The importance of sleep for cognitive health, and effective sleep-improvement strategies for seniors0:33:33 - How emotional health, social connections, and a sense of purpose signif...

2025-03-31•48mins
#11

#341 - Overcoming insomnia: improving sleep hygiene and treating disordered sleep with cognitive behavioral therapy for insomnia | Ashley Mason, Ph.D.

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useAshley Mason is a clinical psychologist and an associate professor at UCSF, where she leads the Sleep, Eating, and Affect (SEA) Laboratory. In this episode, Ashley provides a masterclass on cognitive behavioral therapy for insomnia (CBT-I), detailing techniques like time in bed restriction, stimulus control, and cognitive restructuring to improve sleep. She explains how to manage racing thoughts and anxiety, optimize sleep environments, and use practical tools like sleep diaries to track progress. She also offers detailed guidance on sleep hygiene; explores the impact of temperature regulation, blue light exposure, and bedtime routines; and offers guidance on finding a CBT-I therapist, along with sharing practical steps you can take on your own before seeking professional help.We discuss:0:00:00 - Intro0:01:35 - Defining insomnia: diagnosis, prevalence, and misconceptions0:07:15 - How insomnia develops, and breaking the cycle with cognitive behavioral therapy for insomnia (CBT-I)0:11:39 - The different types of insomnia, and the impact of anxiety, hydration, temperature, and more on sleep0:21:16 - The core principles of cognitive behavioral therapy (CBT) and how CBT-I is used to treat insomnia0:32:37 - Implementing CBT-I: time in bed restriction, sleep scheduling, and the effect of napping0:43:52 - Navigating family and partner sleep schedules, falling asleep on the couch, sleep chronotypes, and more [39:45];0:49:49 - Key aspects of sleep hygiene: temperature, light exposure, and circadian rhythm disruptions0:58:55 - Blue light and mental stimulation before bed, and the utility of A-B testing sleep habits1:04:30 - Other simple interventions that may improve sleep1:10:20 - Ashley’s view on relaxation techniques and mindfulness-based practices1:12:57 - The effectiveness of CBT-I, the role of sleep trackers, and b...

2025-03-24•2hr 24mins
#12

#340 - AMA #69: Scrutinizing supplements: creatine, fish oil, vitamin D, and more—a framework for understanding effectiveness, quality, and individual need

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useIn this "Ask Me Anything" (AMA) episode, Peter explores the complex world of supplements by introducing a practical framework for evaluating their effectiveness and relevance to individual health needs. Rather than providing a simple list of recommendations, Peter aims to equip listeners with the tools to critically assess supplements on their own. He then applies this framework to discuss research on several popular supplements, including creatine, fish oil, vitamin D, B vitamins, and ashwagandha. Additionally, he covers key factors in assessing supplement quality, helping listeners develop a deeper understanding of how to make informed decisions based on their personal health goals.We discuss:01:36 - Overview of episode topics03:12 - How Peter evaluates patients’ supplement regimens, and common misconceptions about supplements vs. pharmaceuticals07:12 - A framework for evaluating supplements11:17 - Evaluating creatine: purpose of supplementation, dosing, and mechanism of action14:19 - Creatine: proven benefits for muscle performance, potential cognitive benefits, and why women may benefit more21:42 - Creatine: risk vs. reward, kidney concerns, and choosing the right supplement23:56 - Evaluating fish oil: its primary purpose as a supplement and how to track levelsIn the full episode, we also discuss:Fish oil: how omega-3s impact inflammation, heart health, and brain function, and the strengths and limitations of current researchFish oil: the risks of supplementation, guidance on selecting high-quality products, and how to determine whether supplementation is appropriateEvaluating vitamin D: understanding deficiency and optimal levelsVitamin D: role in bone health, immune function, potential longevity impact, and biomarker limitationsVitamin D: efficacy, safety, and balancing risk vs. rewardEvaluating B vitamin...

2025-03-17•27mins
#13

#339 - Unpacking trauma: How early wounds shape behavior and the path toward healing | Jeff English

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useJeff English is a trauma-focused clinical counselor with extensive experience working with adults, teens, families, and groups across various settings, including career counseling, life coaching, addiction recovery, professional workshops, and private practice. In this episode, Jeff shares insights from his work as a trauma therapist, exploring how moments of perceived helplessness shape behaviors and how adaptive strategies can become maladaptive over time. He discusses the concept of the “trauma tree,” examining its roots (causes) and branches (consequences), and highlights a powerful framework used at the Bridge to Recovery, a residential workshop where Jeff serves as an outreach specialist. Jeff reflects on the transformative power of group therapy, the role of vulnerability in fostering connection, and the challenges of letting go of control. He also offers practical advice on finding a great trauma therapist, balancing personal growth within relationships, and recognizing when it’s time to seek help.We discuss:0:00:00 - Intro0:01:38 - Defining trauma—a loaded word0:05:14 - The therapeutic process at The Bridge to Recovery: confronting discomfort, embracing vulnerability, and reframing one’s story0:12:31 - The roots of the trauma tree: the foundational wounding experiences that shape adaptive survival behaviors0:19:28 - The branches of the trauma tree: how trauma manifests through co-dependency, addictive patterns, insecure attachments, and more0:27:36 - The connection between trauma manifestations and underlying wounding experiences, trauma triggers, and the importance of surrender in the healing process0:38:41 - How surrendering control, eliminating distractions, and practicing vulnerability are essential components of the healing process0:51:48 - How adaptive behaviors developed during childhood in resp...

2025-03-10•2hr 32mins
#14

#338 ‒ Peter’s takeaways on aerobic exercise and VO2 max, insulin resistance, rising healthcare costs, treating children with autism and ADHD, and strength training | Quarterly Podcast Summary #4

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useIn 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 his discussions on diverse topics such as aerobic efficiency and VO2 max with Olav Aleksander Bu; insulin resistance with Ralph DeFronzo; economics of the US healthcare system and cost-saving strategies with Saum Sutaria; diagnosis and treatment of autism, ADHD, and anxiety in children with Trenna Sutcliffe; and strength training with Mike Israetel. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these fascinating discussions.We discuss:00:00 - Intro01:18 - Overview of topics to be discussed03:58 - Olav Aleksander Bu Pt.2 episode: metrics to track aerobic efficiency and insights about VO2 max, and the ability of increased carbohydrate consumption to boost performance15:46 - The best practices for performing a VO2 max test, the differences between VO2 max training and all-out efforts, and the role of energy intake in endurance performance26:25 - Ralph DeFronzo episode: the pathophysiology of insulin resistance and type 2 diabetes—how they impact different organs, flaws in conventional diabetes treatment, and moreIn the full episode, we also discuss:Understanding type 2 diabetes beyond the traditional triumvirate of features: the “ominous octet” describes changes in other organsPharmacological treatments for insulin resistance and type 2 diabetesThe importance of early detection and intervention in insulin resistanceSaum Sutaria episode: the economic and systemic drivers of high healthcare costs in the U.S.Reducing health care costs: redefining health insurance, lowering drug prices while maintaining innovation, leveraging AI for efficiency, and moreTr...

2025-03-03•29mins
#15

#337 - Insulin resistance masterclass: The full body impact of metabolic dysfunction and prevention, diagnosis, and treatment | Ralph DeFronzo, M.D.

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useRalph DeFronzo is a distinguished diabetes researcher and clinician whose groundbreaking work on insulin resistance has reshaped the understanding and treatment of type 2 diabetes. In this episode, Ralph shares insights from his five decades of research, including his pivotal role in bringing metformin to the U.S. and developing SGLT2 inhibitors. Ralph explores the impacts of insulin resistance on specific organs, the pharmacologic interventions available, and the gold-standard euglycemic clamp method for measuring insulin resistance. This episode is a masterclass in the pathophysiology and treatment of type 2 diabetes, featuring an in-depth discussion of GLP-1 receptor agonists, metformin, and a lesser-known class of drugs that opened Peter’s eyes to new possibilities in diabetes care.We discuss: 0:00:00 - Intro 0:01:10 - Metabolic disease as a foundational driver of chronic illness 0:05:59 - Defining insulin resistance: effects on glucose, fat, and protein metabolism, and how it varies between healthy, obese, and diabetic individuals 0:09:59 - The historical significance of the development of the euglycemic clamp technique for measuring insulin resistance 0:13:38 - How insulin affects different tissues: liver, muscle, and fat cells 0:24:40 - The different ways insulin resistance manifests in various tissues: Alzheimer’s disease, cardiovascular disease, and more 0:28:56 - The dangers of hyperinsulinemia, and the importance of keeping insulin levels within a physiological range 0:38:07 - The challenges of identifying the genetic basis of insulin resistance and type 2 diabetes 0:47:50 - The “ominous octet”—a more comprehensive model of type 2 diabetes than the traditional triumvirate 0:58:45 - The kidneys’ unexpected role in worsening diabetes, and how SGLT2 inhibitors were developed to treat diabetes 1:08:35 - ...

2025-02-24•2hr 45mins
#16

#336 - AMA #68: Fasting, well-balanced diets, alcohol, exercise for busy people, wearables, emotional health, assessing cardiovascular health, and more

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useIn this “Ask Me Anything” (AMA) episode, Peter tackles a diverse set of listener-submitted questions, covering a wide range of health and performance topics. He dives into assessing cardiovascular health, discussing key biomarkers and risk factors, and breaks down various fasting approaches, including time-restricted eating and prolonged fasting. The conversation also explores the impact of alcohol on health and disease risk, fundamental principles of nutrition, and optimal protein intake. Additionally, he examines the pros and cons of ketogenic and low-carb diets, strategies for building effective exercise routines, and the role of wearables in tracking health metrics. The episode concludes with insights on emotional health, making this a well-rounded discussion packed with practical takeaways for anyone looking to optimize their well-being.We discuss:01:08 - Episode format: overview of common health topics based on listener questions02:53 - How to accurately assess your cardiovascular health09:20 - The impact of fasting, time-restricted eating, and dietary restriction on metabolic health14:16 - Alcohol: health risks of consumption, limitations of research, and how to weigh the risks against social and personal enjoyment25:26 - Principles of a well-balanced diet: macronutrients, micronutrients, protein, energy balance, and moreIn the full episode, we also discuss:The benefits and drawbacks of ketogenic diets: impact on satiety, metabolic health, athletic performance, lipid levels, and moreProtein: best sources for muscle growth, total intake, PDCAAS scoring system, and getting adequate amounts on plant-based dietsCreating an effective fitness routine that fits into a busy scheduleThe role of rest and recovery in a workout routineHow to track fitness progress beyond just weight on a scaleThe best low-impact exe...

2025-02-17•28mins
#17

#335 ‒ The science of resistance training, building muscle, and anabolic steroid use in bodybuilding | Mike Israetel, Ph.D.

View the Show Notes Page for This EpisodeBecome a Member to Receive Exclusive ContentSign Up to Receive Peter’s Weekly NewsletterView our full terms of useMike Israetel is a sports physiologist, competitive bodybuilder, and co-founder of Renaissance Periodization, where he coaches athletes and professionals in diet and weight training. In this episode, Mike shares his journey from powerlifting to academia, breaking down the core principles of resistance training, including exercise selection, volume, intensity, and frequency. He debunks common misconceptions about strength training, explains how to structure an effective program for beginners and advanced lifters, and provides candid insights into his experience with anabolic steroids, discussing their effects on muscle growth, performance, and health risks. This conversation offers a deep dive into the science of building muscle, the realities of bodybuilding at the highest levels, and explores the potential of AI-driven breakthroughs to advance human performance and longevity.We discuss:0:00:00 - Intro0:01:07 - Mike’s academic journey, and early experiences in powerlifting, personal training, and sports physiology0:07:25 - Mike’s transition from powerlifting to bodybuilding, and his scientific and artistic approach to sculpting muscle and optimizing aesthetics0:13:28 - The value of strength training, time efficiency, and how it differs from endurance training0:26:38 - Neurological fatigue in strength training: balancing recovery and pushing the limits0:36:06 - The relationship between training intensity and volume, why muscle growth is not linear, and how different approaches affect results0:41:46 - Sustainable and effective approaches to maximizing muscle growth: training close to failure while minimizing fatigue0:51:16 - An efficient and effective resistance training program for beginners with limited time1:10:14 - Advice for finding a good trainer1:18:03 - Troubleshooting training plateaus: optimizing exerci...

2025-02-10•3hr 9mins
#18

#334 - Cardiovascular disease, the number one killer: development, biomarkers, apoB, cholesterol, brain health, and more | Tom Dayspring, M.D.

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use Tom Dayspring is a world-renowned expert in clinical lipidology and a previous guest on The Drive. In this episode, Tom explores the foundations of atherosclerosis and why atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide for both men and women. He examines how the disease develops from a pathological perspective and discusses key risk factors, including often-overlooked contributors such as insulin resistance and chronic kidney disease. He breaks down the complexities of cholesterol and lipoproteins—including LDL, VLDL, IDL, and HDL—with an in-depth discussion on the critical role of apolipoprotein B (apoB) in the development of atherosclerosis. Additionally, he covers the importance of testing various biomarkers, the impact of nutrition on lipid levels, and the vital role of cholesterol in brain health, including how cholesterol is synthesized and managed in the brain, how it differs from cholesterol regulation in the rest of the body, and how pharmacological interventions can influence brain cholesterol metabolism. We discuss: 0:00:00 - Intro 0:01:07 - Defining atherosclerotic cardiovascular disease (ASCVD): development, risks, and physiological impact 0:09:52 - The pathogenesis of ASCVD: the silent development over decades, and the importance of early detection for prevention of adverse outcomes 0:16:52 - Risk factors versus risk markers for ASCVD, and how insulin resistance and chronic kidney disease contribute to atherosclerosis 0:24:19 - How hyperinsulinemia elevates cardiovascular risk 0:30:30 - How apoB-containing lipoproteins contribute to atherosclerosis, and why measuring apoB is a superior indicator of cardiovascular risk compared to LDL cholesterol 0:48:08 - The challenges of detecting early-stage atherosclerosis before calcification appears 0:57:50 - Lp(a)...

2025-02-03•2hr 26mins
#19

#333 ‒ Longevity roundtable — the science of aging, geroprotective molecules, lifestyle interventions, challenges in research, and more | Steven Austad, Matt Kaeberlein, Richard Miller

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use In this special episode of The Drive, Peter introduces a brand-new roundtable format. Joined by three renowned experts in longevity science—Steven Austad, Richard Miller, and Matt Kaeberlein—the group explores the rapidly evolving field of geroscience. Together, they dive deep into topics like the relationship between healthspan and lifespan, evaluating interventions like rapamycin and senolytics, the role of epigenetic changes in aging, and whether GLP-1 receptor agonists hold geroprotective potential. They also tackle major challenges in funding and public acceptance of longevity research including how geroprotective interventions might be tested in humans. Packed with nuanced debate, humor, and groundbreaking insights, this episode is a must-listen for anyone fascinated by the science of aging. We discuss: 0:00:00 - Intro 0:01:07 - The recent rise in public interest in longevity, misconceptions, and the link between healthspan and lifespan 0:10:54 - Redefining healthspan, the US healthcare paradox, and separating longevity science from commercial hype 0:20:48 - The need to redirect medical research from disease-specific models to aging-focused approaches 0:30:19 - Proactive healthcare: rethinking health, disease, and the role of aging 0:35:36 - Biologic age versus chronologic age, and the limitations and potential of epigenetic clocks 0:51:42 - The utility and drawbacks of the “hallmarks of aging” as a framework for research and funding 0:59:22 - The role of epigenetic changes in aging and the challenges of proving causality 1:07:08 - The translational challenges of moving aging research from preclinical studies to human applications 1:22:23 - Distinguishing between a biomarker of aging and aging rate indicators 1:26:32 - The difficulties of translating longevity research in mice to humans, and the diffi...

2025-01-27•2hr 57mins
#20

#332 - AMA #67: Microplastics, PFAS, and phthalates: understanding health risks and a framework for minimizing exposure and mitigating risk

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use In this “Ask Me Anything” (AMA) episode, Peter tackles a topic that's been dominating headlines and sparking widespread concern: microplastics and plastic-associated chemicals, including BPA, PFAS, and phthalates. Peter explores the science behind these substances including how and why they've become so prevalent, the extent of our exposure, and the potential risks to our health. Most importantly, he provides a practical framework for understanding microplastics and plastic-associated chemicals and minimizing exposure while distinguishing genuine risks from exaggerated concerns. We discuss: 00:12 - The complexity of the topic of microplastics and associated chemicals 05:49 - Definitions: microplastics, BPA, PM2.5, phthalates, and more 12:12 - The reasons behind the increase in microplastics in our environment and the surge in interest in them 14:39 - The various ways that humans are exposed to microplastics and nanoplastics 17:15 - Volume of plastic consumed by humans, and how the body eliminates or absorbs microplastics 21:45 - How microplastics accumulate in the body, the variability in tissue accumulation, and the challenges in studying their long-term health effects In the full episode, we also discuss: Limitations of blood tests for microplastics, and the importance of reliable biomarkers for guiding behavior and interventions The speculative health risks of microplastics, the limitations of current research, and the need for more robust studies The challenges of measuring microplastics in human tissues, the need for better methodologies, and the importance of critically evaluating study relevance and claims If it’s unclear whether microplastics actually cause harm, should we still be concerned about exposure? Strategies to minimize microplastic exposure The financial cost and effort involved in variou...

2025-01-20•27mins
#21

#331 ‒ Optimizing endurance performance: metrics, nutrition, lactate, and more insights from elite performers | Olav Aleksander Bu (Pt. 2)

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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 returns to dive deeper into his groundbreaking work as an endurance coach, exercise scientist, engineer, and physiologist. The discussion explores his data-driven approach to coaching, unpacking key performance metrics like functional threshold power, VO2 max, and lactate threshold, while emphasizing the importance of consistent testing protocols. Olav shares insights on how training methodologies differ across sports, the impact of nutrition on endurance performance, and the evolving strategies for carbohydrate metabolism in fueling athletes for races. Olav concludes with a discussion on the use of artificial intelligence for optimizing training insights and performance. We discuss: 0:00:00 - Intro 0:00:40 - Olav’s unique, engineering-driven approach to endurance coaching 0:03:24 - Definitions and applications of key performance metrics: FTP, power, anaerobic threshold, and lactate threshold 0:14:58 - Lactate threshold: factors affecting lactate threshold, testing protocols, and how elite athletes' efficiency affects their performance and lactate profiles 0:24:35 - VO2 max: definition, testing, factors affecting its accuracy, and methods for optimizing oxygen utilization in elite athletes 0:38:47 - Testing VO2 max: common mistakes and key factors to consider—preparation, warm-up, timing, and more 0:47:45 - VO2 max testing continued: measuring instruments, testing protocols, and advanced insights gained from elite athletes 0:57:33 - The influence of supplements like beetroot concentrate and adaptogens on VO2 max and performance 1:02:32 - How respiratory quotient (RQ) reflects metabolic shifts during exercise, the chall...

2025-01-13•2hr 43mins
#22

#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use Trenna Sutcliffe is a developmental behavioral pediatrician and the founder and medical director of the Sutcliffe Clinic in the San Francisco Bay Area, where she partners with families to provide care for children facing behavioral challenges, developmental differences, and school struggles. In this episode, Trenna shares her journey into developmental and behavioral pediatrics, including her pioneering work at Stanford and her expertise in autism, ADHD, and anxiety—the "three As." She explores the diagnostic processes, the overlap and comorbidities of these conditions, and the importance of personalized treatment plans that address both medical and environmental factors. Trenna offers valuable insights into the changing prevalence of autism, the impact of evolving diagnostic criteria, and the range of therapies and medications available to support children and their families. She also discusses the challenges in accessing care and the critical need for a holistic approach that bridges healthcare and education. We discuss: 0:00:00 - Intro 0:01:09 - Trenna’s passion for developmental-behavioral pediatrics (DBP), and the process of diagnosing anxiety, ADHD, and autism 0:08:53 - Understanding anxiety and ADHD: assessing impairment and self-esteem and identifying anxiety and emotional well-being in young patients 0:16:45 - The evolving diagnosis of autism: understanding the spectrum and individual needs 0:28:32 - The dramatic rise in autism spectrum disorder (ASD): genetics, environment, expanded diagnostic criteria, and more 0:41:40 - Exploring epigenetics and the potential multigenerational impact of environment exposures on susceptibility to certain disorders 0:46:22 - The evolution of autism classifications, and the particular challenges for children with level 1 (mild) autism due to a lack of support 0:54:...

2025-01-06•2hr 17mins
#23

Building & Changing Habits | James Clear (#183 rebroadcast)

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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: 0:00:00 - Intro 0:00:09 - Why James became deeply interested in habits 0:04:39 - Viewing habits through an evolutionary lens 0:08:26 - The power of immediate feedback for behavior change, and why we tend to repeat bad habits 0:14:24 - The role of genetics and innate predispositions in determining one’s work ethic and success in a given discipline 0:24:37 - How finding one’s passion can cultivate perseverance and discipline 0:31:32 - Advantages of creating systems and not just setting goals 0:39:54 - The power of habits combined with self-identity to induce change 0:55:14 - How a big environmental change or life event can bring on radical behavioral change 0:59:37 - The influence of one’s social environment on their habits 1:05:52 - How and why habits are formed 1:16:45 - How to make or break a habit with the “Four Laws of Behavior Change” 1:24:08 - Practical tips for successful behavioral change—the best strategies when starting out 1:40:02 - Self-forgiveness and getting back on track immediately after slipping up 1:51:15 - Law : Make it obvious—Strategies for identifying and creatin...

2024-12-30•2hr 35mins

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#24

#329 ‒ Special AMA: Peter on exercise, important labs, building good habits, promising longevity research, and more

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use In this special episode of The Drive, Peter tackles a wide range of listener questions submitted over the past year. The discussion spans essential topics such as exercise—covering grip strength, traveling workouts, and why Peter doesn’t consider exercise an ideal weight-loss strategy—and the top biomarkers everyone should track. He also explores promising new longevity research, his evolving views on longevity, and frameworks like “objective, strategy, tactics” for personalized decision-making. The episode wraps up with insights on building good habits and a glimpse into Peter’s recent reading list. We discuss: 00:11 - Overview of episode topics (and Peter’s car stereo saga) 02:30 - The importance of grip strength and the best methods for training it effectively 15:25 - Exercise while traveling: strategies for staying active and maintaining an exercise routine 19:04 - Why women should prioritize strength training 20:58 - The limited role of exercise in weight loss and its greater importance in improving health, body composition, and insulin sensitivity In the full episode, we also discuss: The “top five most important biomarkers” for assessing health Promising developments in longevity research The development of Klotho as a neuroprotective drug: challenges, timelines of trials, and more Peter’s updated view on the potential of epigenome manipulation to restore aged cells to their youthful state How reversing age-related epigenetic changes in immune cells could revolutionize our approach to aging and disease The “objective, strategy, tactics” framework, and the importance prioritizing impactful lifestyle habits over less significant health trends Strategies for building and maintaining good habits How to think about drugs and supplements as part of a longevity toolkit Peter’s recent reading list More. Conn...

2024-12-16•28mins
#25

#328 - AMA #66: Optimizing nutrition for health and longevity: myth of a “best” diet, complexities of nutrition science, and practical steps for building a sustainable diet

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use In this "Ask Me Anything" (AMA) episode, Peter dives deep into one of the most frequently discussed and often misunderstood topics: nutrition. From weight loss and maintenance to the intricate relationship between nutrition and exercise and body composition, Peter addresses the complexities of nutrition research and explores the perennial question of whether there is a "best diet." He provides practical insights on how to choose the right diet for your unique needs, discusses the role of protein and processed foods, and outlines the key questions to help you optimize your approach to eating. We discuss: 00:11 - The key nutrition-related topics to be discussed 02:18 - Why Peter is not fond of discussing nutrition: limitations of nutrition research, the pitfalls of extreme certainty in dietary discussions, and the body's adaptability to varied diets 09:44 - Key health metrics to monitor to evaluate the effects of nutrition 13:00 - The relationship between nutrition and exercise as they relate to weight loss, maintenance, and gain In the full episode, we also discuss: How increased muscle mass from resistance training impacts calorie burn, body composition, glucose metabolism, and overall health benefits Comparing the impact of fitness and nutrition on lifespan and healthspan: data showing fitness to be a more significant predictor of mortality than nutrition The myth of a “best diet,” factors that determine the effectiveness of a diet, and data suggesting benefits of the Mediterranean diet How long to trial a new diet, the importance of measurable goals, and the appropriate timescales for observing meaningful changes The inherent challenges in nutrition research: variability in dietary exposures, limitations in study design, the body’s adaptive nature which dampen the effects, and more Nutritional approaches ...

2024-12-09•16mins
#26

#327 - Choices, costs, and challenges in US healthcare: insurance intricacies, drug pricing, economic impacts, and potential reforms | Saum Sutaria, M.D.

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use Dr. Saum Sutaria is the Chairman and CEO of Tenet Healthcare and a former leader in McKinsey & Company’s Healthcare and Private Equity Practices, where he spent almost two decades shaping the field. In this episode, Saum unpacks the complexities of the U.S. healthcare system, providing a detailed overview of its structure, financial flows, and historical evolution. They delve into topics such as private insurance, Medicare, Medicaid, employer-sponsored coverage, drug pricing, PBMs and the administrative burdens impacting the system. Saum’s insights help connect healthcare spending to broader economic issues while exploring potential reforms and the role of technology in improving efficiency. Saum highlights how choice and innovation distinguish the U.S. healthcare system, explores the reasons behind exorbitant drug prices, and examines the potential solutions, challenges, and trade-offs involved in lowering costs while striving to improve access, quality, and affordability. The opinions expressed by Saum in this episode are his own and do not represent the views of his employer. We discuss: 0:00:00 - Intro 0:01:38 - The US healthcare system: financial scale, integration with economy, and unique challenges 0:07:08 - Overview of how the US healthcare system currently works and how we got here 0:16:39 - The huge growth and price impact due to the transition from out-of-pocket payments in the 1950s to the modern, third-party payer model 0:20:31 - The unique structure and challenges of the US healthcare system compared to other developed nations 0:26:48 - Overview of Medicare and Medicaid: who they cover, purpose, and impact on healthcare spending 0:31:11 - Why the US kept a employer-sponsored insurance system rather than pursue universal healthcare 0:36:00 - The evolution of healthcare insurance: from catastrop...

2024-12-02•2hr 48mins
#27

Optimizing life for maximum fulfillment | Bill Perkins (#237 rebroadcast)

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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: 0:00:00 - Intro 0:00:08 - Bill’s upbringing, background, and first job on Wall Street 0:13:52 - A missed experience and feeling of regret that shaped Bill’s thinking 0:17:34 - Thinking in terms of time, and the relationship between money, time, and health 0:29:22 - Solving for net fulfillment and allocating your time based on the seasons of life 0:38:56 - How Bill thinks about risk, opportunity costs, and the difference between fear and risk tolerance 0:46:22 - Optimizing for fulfillment, finding purpose outside of work, and more 0:55:55 - Thinking about the order of experiences you want to have based on seasons of life 1:01:26 - Bill’s unique perspective on philanthropy and a more impactful way to give money away 1:13:00 - Applying the principles in ‘Die With Zero’ to maximize fulfillment 1:25:27 - How to break out of living life on autopilot 1:29:51 - When should your net worth peak? 1:34:12 - Taking calculated risks 1:38:45 - Bill shares a lesson from his incredible birthday 1:49:24 - How Bill’s philosophy has evolved since writing Die With Zero Conn...

2024-11-25•2hr 0mins
#28

#326 - AMA #65: Red light therapy: promising applications, mixed evidence, and impact on health and aging

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use In this “Ask Me Anything” (AMA) episode, Peter dives into the world of red light therapy in response to frequent questions from listeners. Peter provides a comprehensive exploration, starting with the basics of red light therapy and why it’s getting so much attention. The conversation examines the latest data on various applications, including aging, skin health, acne, wound healing, hair loss, eye health, exercise performance, metabolic health, weight loss, inflammation, injury recovery, and menstrual cramps. Peter analyzes the scientific literature on each use case and concludes with a summary table that provides an easy-to-follow breakdown of the potential benefits of red light therapy across these areas. We discuss: 00:11 - Overview of topics and the motivation behind exploring red light therapy 01:42 - The basic science of red light therapy 05:13 - The unique penetration properties of red light 08:56 - What happens when tissue is exposed to red light 10:35 - Exploring red light therapy’s potential to combat aging In the full episode, we also discuss: Red light therapy for treating acne Red light therapy for aiding in wound healing Red light therapy for hair loss: promising benefits and practical advice Analyzing the evidence of a positive or negative effect of red light therapy on the eyes Red light therapy’s impact on performance and recovery Red light therapy’s impact on metabolic health: analyzing the limited evidence for improved glucose metabolism Red light therapy for weight loss and targeted fat reduction Red light therapy for inflammation, chronic pain, and injury rehabilitation Red light therapy as a treatment for menstrual cramps Summary: promising applications of red light therapy, unsupported claims, and costs to consider More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

2024-11-18•13mins
#29

#325 ‒ Peter’s key takeaways on bone health, calorie restriction and energy balance, dopamine and addiction, gene editing, and testosterone therapy safety with a prostate cancer diagnosis | QPS #3

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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 his discussions on diverse topics such as dopamine and addiction with Anna Lembke, the current state and exciting future of CRISPR-mediated gene editing with Feng Zhang, how to build and maintain strong bones from youth to old age with Belinda Beck, how calorie restriction may influence longevity and metabolic health with Eric Ravussin, and the role of testosterone and TRT in prostate cancer with Ted Schaeffer. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these engaging discussions. We discuss: 00:00 - Intro 00:09 - Overview of topics to be covered 02:50 - Anna Lembke episode: addiction, dopamine's role in pleasure and pain, and managing addictive behaviors 14:46 - Follow-up questions about addiction: heritability, cold therapy, exercise, and strategies for breaking addictive behaviors 22:08 - Feng Zhang episode: the potential of gene editing with CRISPR technology for treating diseases, and the challenges ahead In the full episode, we also discuss: Feng Zhang’s impactful education experience, and how early exposure and curiosity-driven learning can develop scientific interest for kids The future of CRISPR: weighing the scientific potential to combat complex diseases against ethical considerations around genetic modification Belinda Beck episode: how to build and maintain strong bones from youth to old age How both nutrition and exercise are crucial for bone health at all ages, and why it’s never too late to start Eric Ravussin episode: calorie restriction, energy expenditure, exercise for weight maintenance, and more Measuring energy intake a...

2024-11-11•25mins
#30

#324 ‒ Metabolism, energy balance, and aging: How diet, calorie restriction, and macronutrients influence longevity and metabolic health | Eric Ravussin, Ph.D.

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use Eric Ravussin is a world-renowned expert on obesity, metabolism, and aging whose pioneering research has shaped much of what we understand today about energy balance and caloric restriction. In this episode, Eric shares insights from his cutting-edge work on energy expenditure—a critical factor in understanding how our bodies regulate weight and appetite. He discusses methods for measuring energy output, energy balance, food intake, and appetite regulation, and explores key studies on macronutrient manipulation. Eric then delves into the CALERIE study on caloric restriction, highlighting insights related to biomarkers of both primary and secondary aging. The conversation also covers the potential of GLP-1 agonists to replicate these effects and looks ahead to how AI and technology could transform metabolic research in the coming years. We discuss: 0:00:00 - Intro 0:01:34 - Eric’s background and current work metabolism and measuring energy expenditure 0:07:18 - The science behind metabolic chambers for measuring energy expenditure, and the complexities of indirect and direct calorimetry 0:17:47 - The body's regulatory systems for maintaining energy balance and the primary influence of energy intake on body weight 0:25:00 - The epidemic of obesity and a discussion of resting metabolic rate 0:29:15 -The impact of exercise, appetite, gut hormones, and eating patterns on weight regulation 0:40:11 - Experiments looking at how macronutrient composition affects energy expenditure 0:54:05 - The challenges of studying diet in real-life settings, the potential of personalized nutrition, and how public health policy could play a role in guiding nutritional habits 1:13:27 - The importance of protein in the diet, the limitations of dietary data collection, and how AI could potentially transform nutrition science 1:21:30 ...

2024-11-04•2hr 21mins
#31

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

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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: 0:00:00 - Intro 0:01:32 - Feng’s background, experience in developing optogenetics, and his shift toward improving gene-editing technologies 0:10:05 - The discovery of CRISPR in bacterial DNA and the realization that these sequences could be harnessed for gene editing 0:21:48 - How the CRISPR system fights off viral infections and the role of the Cas9 enzyme and PAM sequence 0:29:48 - The limitations of earlier gene-editing technologies prior to CRISPR 0:39:08 - How CRISPR revolutionized the field of gene editing, potential applications, and ongoing challenges 0:51:59 - CRISPR’s potential in treating genetic diseases and the challenges of effective delivery 0:57:55 - How CRISPR is used to treat sickle cell anemia 1:05:51 - Gene editing with base editing, the role of AI in protein engineering, and challenges of delivery to the right cells 1:13:10 - How CRISPR is advancing scientific research by fast-tracking the development of transgenic mice 1:17:43 - Advantages of Cas13’s ability to direct CRISPR to ...

2024-10-28•2hr 21mins
#32

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

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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: 0:00:00 - Intro 0:00:59 - Belinda’s journey into bone health research and training 0:07:12 - The physiology of bone and how bones adapt to mechanical loading 0:13:51 - Bone development from birth to adulthood, why early life is a crucial period, the functions of osteoblasts and osteoclasts, and gender differences in BMD 0:29:05 - How parents can optimize their children’s bone health through diet (calcium and vitamin D), sunlight exposure, and physical activity 0:50:25 - The best sports and activities for promoting bone health, weight training for kids, and advice for parents 0:53:00 - The impact of corticosteroid use on bone health in children and strategies to minimize negative effects 0:57:15 - Advice for people in middle age to preserve bone density: physical activity and bone-loading exercises 1:06:08 - Bone loss during the menopause transition for women: hormone replacement therapy and other strategies to mitigate BMD losses 1:10:20 - Interpreting the bone mineral density results from a DEXA...

2024-10-21•1hr 51mins
#33

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

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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: 0:00:00 - Intro 0:01:11 - The role of dopamine and the prefrontal cortex in addiction 0:12:18 - The clinical definition of addiction and the behavioral criteria for diagnosing it 0:16:44 - Assessing alcohol use: patterns, risks, and addiction diagnosis 0:21:38 - Applying the addiction diagnosis framework using gambling as an example 0:25:48 - Exploring addiction variability: how nature, nurture, and access shape individual vulnerability and drug of choice 0:43:33 - How abstinence from addictive behaviors can help reset the brain’s reward system and improve mental health 0:54:29 - Safely abstaining from addiction substances, drugs needing medical supervision, and other key considerations 1:02:40 - Transitioning from abstinence to long-term recovery: tools and considerations 1:13:18 - Exploring behavioral addictions like sex addicti...

2024-10-14•2hr 34mins
#34

#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

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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. We discuss: 00:09 - The rapidly evolving landscape of GLP-1 agonists 5:14 - The mechanism of GLP-1 agonists, their origin as diabetes treatments, and how they evolved into weight-loss drugs 09:08 - Overview of new data and open questions related to the benefits and risks of GLP-1 agonists 16:19 - New insights into the long-term safety of GLP-1 agonists, side effects, and more In the full episode, we also discuss: The long-term efficacy of GLP-1 agonists, financial barriers, and more; The mechanisms behind GLP-1 agonists' ability to promote weight loss; New data on body weight changes after discontinuing the drug; Effects of GLP-1 agonists on lean mass and body composition, and the role of protein and resistance training in preserving muscle; Semaglutide vs. tirzepatide: comparing benefits and side effects; How compounding pharmacies affect availability of GLP-1 drugs and the types of formulations that are available; How do oral formulations of G...

2024-10-07•19mins
#35

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

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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. We discuss: 00:00 - Intro 00:10 - Overview of topics, and the positive feedback on the quarterly podcast summary format 02:28 - Julia Wattacheril episode: liver health and disease 15:27 - Noninvasive methods to diagnose liver conditions, and how to manage and improve liver health In the full episode, we also discuss: Joel Jamieson episode: heart rate variability (HRV) for training and health; Practical tools for measuring HRV and how it informs training and recovery decisions; Zak Kohane episode: artificial intelligence and medicine; The current role of AI in medicine and how it could revolutionize medicine in the future; The limitations and concerns pertaining to AI; Dena Dubal episode: the potential benefits of klotho for brain health; Animal studies on klotho and brain health; Genetics-based variations in klotho levels in humans and their impact on cognition, disease risk, and longevity; Testing klotho levels, the significance of the KL-VS variant, the role of exercise in increasing klotho, and more; The potential of klotho as a treatment for cognitive decline and Alzheimer's disease; George Brooks episode: a new paradigm to think about lactate and lactate metabolism; The potential for lactate infusions to aid ...

2024-09-30•27mins
#36

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

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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: 0:00:00 - Intro 0:01:38 - 2020 Tour de France win 0:06:54 - Learning from previous mistakes 0:09:04 - Training: simulating steep climbs and other challenging race conditions 0:11:49 - Tadej’s historic 2024 season and what contributed to his success 0:15:30 - Nutrition for optimal performance: offseason diet and carbohydrate intake during intense training sessions 0:18:51 - Training metrics: heart rate, power output, VAM, and HRV, and his approach to zone 2 training 0:28:11 - Epic climbs in the Tour de France, mindset after challenging stages, and rebuilding confidence after the 2023 Tour 0:36:35 - Racing dynamics, media criticism, and Tadej’s reflections on racing records 0:45:02 - Training in the off-season Connect With Peter on Twitter, Instagram, Facebook and YouTube

2024-09-23•52mins
#37

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

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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: 0:00:00 - Intro 0:01:10 - The issue of groupthink and cognitive dissonance in science and medicine 0:06:30 - How a non-operative treatment for appendicitis sheds light on cognitive dissonance 0:13:22 - How cognitive dissonance and effort justification shape beliefs and actions 0:17:53 - How misguided peanut allergy recommendations created an epidemic 0:26:15 - The enduring impact of misinformation and fear-based messaging around hormone replacement therapy allegedly causing breast cancer 0:29:13 - The dangers of extreme skepticism and blind faith in science, and the importance of understanding uncertainty and probability 0:35:45 - The overuse of antibiotics and the rise of antibiotic resistant infections and poor gut health 0:43:09 - The potential correlations between early antibiotic use and chronic diseases 0:53:29 - The hi...

2024-09-16•2hr 14mins
#38

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

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter 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 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 a...

2024-09-09•20mins
#39

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

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter 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 populari...

2024-09-02•2hr 32mins
#40

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

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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: 0:00:00 - Intro 0:00:43 - How Sebastian’s near-death experience shaped his thinking about mortality and gave him a reverence for life 0:04:50 - The aneurysm that led to Sebastian’s near-death experience 0:16:19 - Emergency room response, his subsequent reflections on the event, and the critical decisions made by the medical team 0:27:04 - Sebastian’s reaction to first learning he nearly died, and the extraordinary skill of the medical team that save his life 0:40:54 - Sebastian’s near-death experience 0:53:31 - The psychological impact of surviving against overwhelming odds 1:01:18 - Ignored warning signs: abdominal pain and a foreshadowing dream before the aneurysm rupture 1:05:43 - Sebastian's recovery, his exploration of near-death experiences, and the psychological turmoil he faced as he questioned the reality of his survival 1:11:38 - A transformative encounter with a nurse who encouraged Sebastian to view his near-death experience as sacred 1:17:50 - How Sebastian has changed: a journey toward emotional awarenes...

2024-08-26•2hr 22mins
#41

#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.

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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: 0:00:00 - Intro 0:01:59 - The complex relationship between nutrition, body weight, and body composition 0:07:27 -The slow progress in addressing obesity and public health despite substantial effort and investment 0:18:18 - The very limited success of public health initiatives in curbing obesity 0:28:10 - The evolving landscape of obesity research: public health initiatives and the impact of pharmacological success 0:34:52 - Rethinking obesity solutions: the need for a paradigm shift 0:44:42 - Understanding environmental triggers and embracing a balanced approach to addressing obesity that includes both pharmacological treatments and realistic lifestyle changes 0:56:18 - The need for higher standards in obesity research 1:08:01 - The rapid success of GLP-1 recep...

2024-08-19•2hr 9mins
#42

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

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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. We discuss: 00:12 - Overview of episode topics (and an important discussion on fanny packs) 03:03 - Understanding uric acid: its role in metabolic processes, its association with gout and kidney stones, its impact on blood pressure, and more 10:03 - Non-modifiable factors that influence uric acid levels 13:39 - Modifiable factors that influence uric acid levels 20:05 - Association between high uric acid levels and cardiovascular disease In the full episode, we also discuss: 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 consequenc...

2024-08-12•23mins
#43

#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.

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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: 0:00:00 - Intro 0:00:12 - Our historical understanding of lactate and muscle metabolism: early misconceptions and key discoveries 0:15:02 - Fundamentals of metabolism: how glucose is metabolized to produce ATP and fuel our bodies 0:23:49 - The critical role of lactate in energy production within muscles 0:31:30 - Lactate as a preferred fuel during high-energy demands: impact on fat oxidation, implications for type 2 diabetes, and more 0:45:55 - How the infusion of lactate could aid recovery from traumatic brain injuries (TBI) 0:53:51 - The effects of exercise-induced lactate 0:56:35 - Metabolic differences between highly-trained athletes and insulin-resistant individuals 1:04:21 - How training enhances lactate utilization and facilitates lactate shuttling between fast-twitch and slow-twitch muscle fibers 1:12:44 - The growing recognition of lactate and monocarboxylate transporters (MCT) 1:16:21 - The intrica...

2024-08-05•2hr 23mins
#44

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

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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: 0:00:00 - Intro 0:01:17 - Overview of episode topics and structure 0:03:14 - How Peter defines longevity 0:12:18 - Why healthspan is a crucial component of longevity 0:17:04 - The evolution of medicine from medicine 1.0 to 2.0, and the emergence of medicine 3.0 0:28:33 - Overview of atherosclerotic diseases: the 3 pathways of ASCVD, preventative measures, and the impact of metabolic health 0:36:15 - Cancer: genetic and environmental factors, treatment options, and the importance of early and aggressive screening 0:43:15 - Neurodegenerative diseases: causes, prevention, and the role of genetics and metabolic health 0:47:20 - The spectrum of metabolic diseases 0:48:32 - Why it’s never too late to start thinking about longevity 0:51:16 - The 5 components of the longevity toolkit 0:52:36 - Peter’s framework for exercise—The Centenarian Decathlon 1:05:04 - Peter’s nutritional framework: energy balance, protein intake, and more 1:15:27 - Sleep: the vital role of sleep in longevity, and how to improve sleep habits 1:21:19 - Drugs and supplements: Peter’s framework for thinking about drugs and supplements as tools for enhancing longevity 1:24:59 - Why emotional health is a key component of longevity 1:28:06 - A...

2024-07-29•1hr 32mins
#45

#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.

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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: 0:00:00 - Intro 0:01:22 - Background on the TRAVERSE trial: insights into exogenous testosterone and prostate cancer risk 0:09:50 - The androgen receptor saturation theory: how different organs respond to varying levels of testosterone 0:16:15 - The relationship between testosterone levels and prostate cancer aggressiveness: how aggressive prostate tumors have lower androgen receptor activity and rely on different growth mechanisms 0:24:44 - Using the Decipher score to assess prostate cancer aggressiveness and guide personalized treatment strategies 0:33:12 - Considerations for testosterone replacement therapy: how Ted counsels patients, how TRT can be safely administered in patients with low-grade prostate cancer, and more 0:41:37 - Advancements i...

2024-07-22•51mins
#46

#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.

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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: 0:00:00 - Intro 0:01:08 - Zak’s unconventional journey to becoming a pioneering physician-scientist, and his early interactions with GPT-4 0:07:56 - The evolution of AI from the earliest versions to today’s neural networks, and the shifting definitions of intelligence over time 0:21:00 - 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 0:32:16 - An AI breakthrough in medicine: the ability to accurately recognize retinopathy 0:36:02 - Third generation AI: how improvements in natural language processing significantly advanced AI capabilities 0:42:59 - AI concerns and regulation: misuse by individuals, military applications, displacement of jobs, and potential existential concerns 0:58:16 - How AI is enhancing image-based medical specialties like radiology 1:06:14...

2024-07-15•2hr 19mins
#47

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

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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: 0:00:00 - Intro 0:00:10 - The amazing potential of cyclist Tadej Pogačar 0:06:54 - Metrics for assessing athletic performance in cyclists and how that impacts race strategy 0:17:20 - The impact of performance-enhancing drugs and the potential for transparency into athletes’ data during competition 0:26:06 - Tadej Pogačar’s race strategy and mindset at the Tour de France 0:29:58 - Defining Zone 2, fat oxidation, and how they are measured 0:40:04 - Using fat and carbohydrate utilization to calculate the mitochondrial function and metabolic flexibility 0:44:33 - Lactate level...

2024-07-08•3hr 16mins
#48

#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

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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. We discuss: 00:11 - The impact of UV radiation on the skin 02:38 - Understanding solar UV: from the electromagnetic spectrum to skin health 07:12 - The role of sunlight in vitamin D production 08:45 - Factors contributing to vitamin D deficiency: insufficient UV exposure, magnesium levels, and more 11:22 - Sun exposure needs for different skin types, and the limitations of current studies in defining vitamin D deficiency 15:10 - The acute and long-term effects of excessive UV exposure: sunburn, photoaging, and the increased risk of skin cancer 17:40 - Types of skin cancer and associations with UV exposure In the full episode, we also discuss: 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 facto...

2024-07-01•20mins
#49

#307 ‒ Exercise for aging people: where to begin, and how to minimize risk while maximizing potential | Peter Attia, M.D.

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter View our full terms of use 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: 0:00:00 - Intro 0:00:39 - Key points about starting exercise as an older adult 0:04:02 - Why it’s never too late to begin exercising and incorporating the four pillars of exercise 0:08:59 - The gradual, then sharp, decline in muscle mass and activity level that occur with age 0:14:44 - The decline of VO2 max that occurs with age 0:17:43 - Starting a training program: exercise variability, movement quality, realistic goals, and more 0:25:16 - Improving aerobic capacity: the malleability of the system, the importance of consistency, and setting long-term fitness goals 0:31:33 - Starting cardio training: base building, starting with low volume, and zone 2 training 0:38:17 - The critical role of VO2 max in longevity 0:48:04 - How to introduce VO2 max training to older or deconditioned individuals 0:57:02 - Options for performing zone 2 and VO2 max training 1:00:49 - The ability to make gains in strength and muscle mass as we age 1:05:21 - How to implement strength training for older individuals 1:12:40 - Advice for avoiding injury when strength traini...

2024-06-24•1hr 48mins

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