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Episode Description:

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

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

We discuss:

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

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Episode Description:

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

We discuss:

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

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Episode Description:

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

We discuss:

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

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

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

We discuss:

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

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Today’s episode of The Drive is a rebroadcast of the conversation with Iñigo San Millán, (released on December 23rd, 2019). This episode with Iñigo was one of the most popular discussions to date and is a prelude to an upcoming follow-up discussion in 2022.

In this episode, Dr. Iñigo San Millán, Assistant Professor at the University of Colorado School of Medicine, explains the crucial role of mitochondrial function in everything from metabolic health to elite exercise performance. Iñigo provides a masterclass into the many different energy system pathways, the various fuel sources (including the misunderstood lactate), the six zones of exercise training, and the parameters he uses to measure metabolic health. Additionally, he highlights the power of zone 2 training as both an effective diagnostic tool and, perhaps more importantly, as a treatment for mitochondrial and metabolic dysfunction.

We discuss:

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

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

Today’s episode of The Drive is a rebroadcast of the conversation with Rick Johnson (originally released January 6th, 2020). This episode was one of the most popular discussions to-date and is a prelude to an upcoming follow-up discussion which will be coming out in February 2022 along with the release of Rick’s new book.

In this episode, Rick Johnson, professor of nephrology at the University of Colorado, explains how his research into the causes of blood pressure resulted in a change of research direction to focus more on how fructose has such profound metabolic effects. Rick begins by talking about the relationship between salt and high blood pressure, then provides a masterclass into uric acid, and then expertly reveals the mechanisms and pathways by which sugar (specifically fructose) can profoundly impact metabolic health. From there, he explains how he applies this information to real life patients as well as touches on some of the most promising ideas around pharmacotherapy that are being developed in response to the epidemics of fatty liver, insulin resistance, diabetes, and obesity. Furthermore, Rick gives his take on artificial sweeteners compared to real sugar, discusses cancer’s affinity for fructose, and much more.

We discuss:

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

In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss all things related to GLP-1 agonists—a class of drugs that are gaining popularity for the treatment of obesity. They cover the discovery of these peptides, their physiology, and what it is they do in their natural state. Next, Peter and Bob break down a recently published study which showed remarkable results for weight loss and other metabolic parameters using a once-weekly injection of the GLP-1 agonist drug semaglutide, also known as Ozempic, in overweight and obese patients. Finally, they compare results from the semaglutide study to results from various lifestyle interventions and give their take on the potential future of GLP-1 agonists.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #29 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss all things related to testosterone: what happens when testosterone levels are low, and the potential benefits and risks of testosterone replacement therapy (TRT). They explain the physiology of testosterone, how it works, and how its level changes over the course of a person's life. They have a detailed discussion about existing literature, which reveals vast potential structural, functional, and metabolic benefits of testosterone replacement therapy. They also take a very close look at potential risks of this therapy, with a focus on the controversial effects on cardiovascular disease and prostate cancer.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #28 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss the longevity benefits from greater cardiorespiratory fitness (CRF) and greater muscle mass and strength. Conversely, they dive deep into the literature showing a rapid increase in morbidity and mortality risk as fitness levels decline with age. They also try to tease out the relative contributions of CRF, muscle mass, and strength. Additionally, they discuss the impact of fasting on muscle mass, the potential tradeoffs to consider, and finish by discussing why it’s critical to maximize your fitness level.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #27 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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In this “Ask Me Anything” (AMA) episode, Peter and Bob answer numerous follow-up questions to recently discussed deep-dive topics such as the use of continuous glucose monitors and getting the most from zone 2 exercise. They also discuss the incredible feats of cyclists in the Tour de France through the lens of the amazing performance physiology required from these athletes. Additionally, Peter ties the conversation together by sharing his foundational framework when considering different interventions, even in the absence of data from a randomized controlled trial.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #26 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

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

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

We discuss:

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

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In this “Ask Me Anything” (AMA) episode, Peter and Bob dive deep into cancer screening, including why it’s important, what you need to know about a test, and Peter’s approach with patients. They specifically discuss various screening methods, explain important terms like sensitivity and specificity, and how layering and stacking different tests in tandem can improve predictive values. They conclude with a discussion on one of the more exciting screening tools, diffusion-weighted MRI, and how it’s changing the cancer screening landscape.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #25 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

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

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

We discuss:

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

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

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

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

We discuss:

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

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In this “Ask Me Anything” (AMA) episode, Peter and Bob dive deep into nicotine, a complicated and interesting molecule that has effects on both the brain and the body. They analyze the results of the studies that describe nicotine’s cognitive benefits and potential for inducing weight loss. They talk about a smoking cessation technique called nicotine replacement therapy and give a full breakdown of the various routes of administration, dosing, and safety. Finally, they explore the fascinating and counterintuitive observation that cigarette smokers are less likely to get a severe case of COVID-19.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #23 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

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

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

We discuss:

• Overview and current status of the SARS-CoV-2 vaccine strategies [4:10];

• Addressing concerns about mRNA vaccines [9:00];

• How the failure to make an effective HIV vaccine aided the development of a COVID-19 vaccine [16:45];

• Where SARS-CoV-2 falls on the spectrum of its ability to mutate and what that means for immunity and vaccination [21:30];

• How the combination of short-term and long-term immune response to SARS-CoV-2 work together to provide durable immunity [28:00];

• Importance of understanding relative vs. absolute risk reduction [38:15];

• Implications of pausing the J&J vaccine due to reports of blood clotting in the brain [42:45];

• What constitutes herd immunity and the concerns of rising vaccine hesitancy [47:45];

• When we might reach herd immunity, future vaccines for children, and long-term outlook for maintaining population immunity [58:45];

• Theories about the origins of SARS-CoV-2 [1:07:00];

• Preparing for the possibility of a future pandemic and how we can learn from our mistakes [1:10:40]; and

• More.

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

We discuss:

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

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

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We discuss:

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

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

We discuss:

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

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

We discuss:

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

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

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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In this episode, Sam Harris, neuroscientist, author, and host of the Making Sense Podcast, joins Peter to discuss this unprecedented coronavirus (COVID-19) crisis. The discussion includes the important distinction between COVID-19 and influenza, the impact on the economy, the dire situation in New York, and the challenge of creating a safe and effective vaccine. Additionally, Sam brings insights from his extensive meditation practice to help those struggling with stress, anxiety, and fear in this extraordinary situation.

We discuss:

• A time unlike any other—why many people don’t seem to fully grasp the magnitude of this situation [2:00];
  
• Why comparing COVID-19 to influenza is a bad analogy [10:45]
  
• The impact on the economy of measures like shelter-in-place—Is the “cure” worse than the disease? [16:45];
  
• Why are some places, like New York, getting hit so much worse? [24:45];
  
• The trickle down effect of an overrun healthcare system on non-COVID-19 related health issues [34:45];
  
• How to calm our minds and manage our emotions during this craziness [38:00];
  
• Talking to kids about this situation without burdening them with undue stress [50:15];
  
• Insights from meditation practice—Recognize and unhook yourself from a heightened emotional state [52:00];
  
• How to make the most of a situation where you let your emotions get the best of you [59:15];
  
• What are some potential positive things that Sam hopes could be learned from this crisis and applied to the future? [1:09:30];
  
• The unfortunate politics being layered on top of this crisis [1:15:30];
  
• The challenge of creating a safe and effective vaccine for COVID-19 [1:20:00]; and
  
• More.

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Show notes page for this episode: https://peterattiamd.com/samharris2

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In this episode, Dr. Peter Hotez M.D., Ph.D., Dean for the National School of Tropical Medicine Baylor College of Medicine, returns to continue the conversation on COVID-19. Dr. Hotez informs us on how we can gauge the number of infected people, behaviors to reduce the probability of becoming infected, and the inconsistency of hospitalizations among young adults between different countries.  Dr. Hotez underscores the continued uncertainty in many virus-related developments, but ends with some points of optimism.

Disclaimer: This is information accurate as of March 19, 2020, when it was recorded.

We discuss:

• • How to gauge true number of infected people [5:45]
    
  • Reducing the probability of getting infected [22:45]
    
  • Inconsistency by country in infected young people [27:15]
    
  • Conferred immunity, seasonality, and repurposed therapeutics [30:30]
    
  • Vaccine development [39:30]
    
  • Practical behaviors to reduce risk of transmission [46:00]
    
  • Mental Health resource and funding [51:00]
    
  • Points of optimism [56:00]; and
    
  • More.
    

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/peterhotez-2

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Today's episode of The Qualys is from podcast #47 – Matthew Walker, Ph.D., on sleep – Part I of III: Dangers of poor sleep, Alzheimer’s risk, mental health, memory consolidation, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

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In this episode, Dr. Paul Grewal, M.D. joins Peter to discuss what they have learned in the past week in the midst of the rapid changes surrounding the COVID-19 pandemic. Their conversation touches on both optimism and uncertainty: actionable steps we can take to improve the situation with the understanding that it is too late for viral containment. Specifically, Peter and Paul discuss some promising drug treatment, reasons for isolating-behavior adoption, and what they are personally instituting in their own lives.

Disclaimer: This is information accurate as of March 13, 2020, when it was recorded.

We discuss:

• When the gravity of Coronavirus (COVID-19) hit home [04:30];
  
• Hospitalization and ICU bed space as an issue [8:15];
  
• Natural history and pathology of COVID-19 [12:00];
  
• Potential drug therapies [22:00];
  
• How thinking has changed from containment to management [30:00];
  
• What Paul and Peter are doing [49:00];
  
• What we know about viral transmission [57:00]; and
  
• More.

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/covid-19-update-03152020/

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In this episode, Dr. Peter Hotez M.D., Ph.D., Dean for the National School of Tropical Medicine Baylor College of Medicine, shares his expertise on viral disease and how it applies specifically to the coronavirus disease (COVID-19) and the virus that causes it (SARS-CoV-2). Dr. Hotez informs us about the current state of disease progression, which has many unknowns, but has thus far been greatly determined by the delayed response time and lack of testing. Moreover, we discuss what we can do on a country, state, community, and individual level in order to collectively slow transmission of the disease. He shares with us a potential hope in convalescent plasma therapy and underscores the need for US federal involvement - particularly in the creation of a specialty task force to address areas of concern and unknowns.

Disclaimer: This is information accurate as of March 13, 2020, when it was recorded.

We discuss:

• The disease and the virus: transmissibility and lethality [04:30];
  
• Disease transmission: US playing catch-up [12:00];
  
• Convalescent plasma coronavirus therapy [16:00];
  
• Remdesivir drug treatment and vaccination challenges [19:45];
  
• Disease mechanism and reported pathology [27:45];
  
• Most concerning geographic regions in the US [39:00];
  
• Risk reduction [46:30]; and
  
• More.

Learn more: https://peterattiamd.com/

Show notes page for this episode:  https://peterattiamd.com/peterhotez

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Today's episode of The Qualys is from podcast #37 – Zubin Damania, M.D.: Revolutionizing healthcare one hilariously inspiring video at a time.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

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In this episode, David Epstein, best-selling author of Range and The Sports Gene, discusses the evidence around the most effective ways to improve long-term performance and learning in our specialties, our sports, our careers, and our lives. David makes a compelling case that a range of experiences and skills are more likely to lead to expert performance compared to early specialization, and offers an in-depth critique of the much-publicized 10,000-Hour Rule. David also provides insights into our role as parents in the process of encouraging exposure to many things, the concepts of when to push them, when to give them space, and when to allow them to quit. Furthermore, David goes into many other fascinating topics such as the role of talent, genetics, and practice in reaching expert status, what differentiates a kind vs. wicked learning environment, the importance of “informal training,” and many case studies that suggest strategies for short-term success may not be best for long-term development.

We discuss:

• A shared interest in Ayrton Senna, and pondering the value in participating in sports [2:30];

• Examining the 10,000-Hour Rule, and the importance of questioning existing dogma [15:00];

• How the medical profession is affected by bad science, and the importance of understanding individual variation [28:00];

• David’s most surprising findings when writing The Sports Gene [35:45];

• Kind versus wicked learning environments [40:45];

• How and why strategies for short-term success may not be best for long-term development [47:30];

• Contrasting the success stories of Tiger Woods and Roger Federer—which path is more common, and an argument for diversified training and experiences [59:15];

• Is there an age-range or “critical window” during which exposure is necessary to reach a certain level of proficiency or mastery of a skill or knowledge? [1:14:00];

• How diversifying your interests and unraveling your identity from your speciality could lead to more enjoyment and actually improve performance in your speciality [1:22:15];

• The undervalued importance of “informal training” [1:29:15];

• Advice for increasing match quality in your work—where interests and abilities align—to optimize both job performance and fulfillment [1:41:15];

• Would David want his own son to attend college given the current state of higher education? [1:51:15];

• The role of a parent—how to encourage sampling, when to push them, when to allow them to quit, and insights from the childhoods of Tiger Woods and Wolfgang Mozart [1:55:45];

• The need for varied perspectives and the ability to improvise—insights gained from the Space Shuttle Challenger tragedy [2:08:45];

• How a diversified background and identity could be the difference in life or death—the Hotshot firefighters case study [2:22:15];

• David’s takeaways from the inspiring story of Frances Hesselbein [2:29:00]; and

• More.

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Show notes page for this episode: https://peterattiamd.com/davidepstein

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Today's episode of The Qualys is from podcast #52 – Ethan Weiss, M.D.: A masterclass in cardiovascular disease and growth hormone – two topics that are surprising interrelated.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

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In this episode, Luke Bennett, Medical and Sports Performance Director for Hintsa Performance, explains the ins and outs of Formula 1 with a focus on the behind-the-scenes human element, and what makes it so emotionally, cognitively, and physically demanding for the drivers as well as the many team members. Luke first talks about his fascinating background with the Royal Flying Doctor Service in Australia, which lead to his current position with Hintsa working closely with F1 drivers to improve their health and performance despite jet-lag and sleep constraints due to an unrivaled travel schedule. Luke also sheds light on the underappreciated level of sheer physical strength and endurance it takes to drive an F1 car combined with the extreme cognitive aptitude, spatial awareness, and ability to navigate a socially complex environment that is needed to be successful as a driver. Additionally, Luke gives an overview of how the F1 season and races work, the incredible advances in car technology and safety measures, and what Luke and Hintsa hope to bring in the near future to the unique and special sport that is Formula 1.

We discuss:

• What it’s like to be a “flying doctor” in Australia, and how Luke ended up working in Formula 1 with Hintsa [3:10];
  
• Behind the scenes of Formula 1—crazy travel, jet lag, massive teams, and fascinating human storylines [10:45];
  
• The incredible physical strength and cognitive aptitude needed to be a F1 driver [19:00];
  
• The technological leap to hybrid electric engines [29:30];
  
• The trend towards younger drivers in F1 [32:30];
  
• Advancements in safety—the history and recent upgrades [36:00];
  
• How Hintsa manages the athletes through the incredible social complexity of the sport [41:45];
  
• Explaining the difference between F1, F2, F3, and F4, and the path to reaching the F1 [47:30];
  
• Comparing F1 in the 60s & 70s to today—Incidences of deaths, number of crashes, physicality of driving, new regulations, and more [53:45];
  
• Women in F1—Past, present, and future [1:06:10];
  
• How F1 teams manage their cars and engine over the season, & some new regulations coming in 2021 [1:09:15];
  
• What insights has Luke taken from his time as a triathlete to working with F1 drivers? [1:12:50];
  
• How Luke survived cancer, and gained an increased sense of empathy [1:15:45];
  
• How Luke manages his health against the brutal travel and lifestyle that comes with working in Formula 1 [1:19:40];
  
• New training techniques, technology to monitor the physiology of drivers, and other things Luke is hoping to bring to Formula 1 [1:22:40];
  
• How long does it take a driver to learn a new circuit? [1:27:45];
  
• The incredible emotional control needed to be a successful F1 driver [1:30:00];
  
• Which F1 teams are showing signs of competing in future seasons? [1:32:15]; and
  
• More.

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/lukebennett

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Today's episode of The Qualys is from podcast #05 – Dom D’Agostino, Ph.D.: ketosis, n=1, exogenous ketones, HBOT, seizures, and cancer.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ 

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In this episode, Mark Hyman, M.D., director of the Cleveland Clinic Center for Functional Medicine and the author of Food Fix, discusses that if we can fix the food system, we can solve many big problems—namely the chronic disease/obesity epidemic, the rising costs of healthcare, as well as the big problems facing the environment. Mark first briefly lays out the health consequences of processed food with a focus on the gut microbiome. From there, Mark discusses the environmental consequences of industrial farming and lays out how we can affect change on the individual level, through policy and regulations, and perhaps most importantly through regenerative agriculture. Additionally, Mark talks about the potential health risks of consuming GMO foods, herbicides, and other chemicals used in industrial farming as well as the environmental consequences, such as the loss of soil, caused by those same fertilizers and methods of farming.

We discuss:

• The negative consequences of the existing food environment [3:25];
  
• What makes processed food so unhealthy? [9:00];
  
• The gut microbiome: Inflammation from gut permeability and how to measure gut health [18:30];
  
• Steps to fixing a bad gut—The Five R’s [24:30];
  
• Some staggering health statistics, and which races might be more genetically susceptible [27:15];
  
• An argument for government regulations and policies to fight back against a massive food industry with unlimited resources (and what we can learn from the tobacco story) [29:00];
  
• Industrial farming and climate change: The degradation of soil and use of fertilizer [41:45];
  
• Regenerative agriculture: Could it be the answer to food waste, our health problems, and the environment? [51:45];
  
• Comparing the Impossible Burger to regeneratively raised beef [1:06:00];
  
• GMO and Roundup—The potential health risks of consuming GMO foods sprayed with Roundup (glyphosate) and other herbicides and pesticides [1:08:15];
  
• How the livelihood of farmers are being affected by big ag companies and the current industrial farming system [1:16:30];
  
• The loss of biodiversity in our food, and what “organic” really means [1:19:00];
  
• What can people do on the individual level to protect themselves as well as affect change to the toxic food system? [1:25:00];
  
• What role does the USDA play in this “toxic” food environment and how do we fix it? [1:30:15];
  
• The top 3 changes Mark would make if he was “food czar” [1:35:15];
  
• Mark’s rebuttal against the argument that it’s best for the environment if we stop farming animals and move to a fully plant-based diet (and his argument for “agriculture 2.0") [1:36:30];
  
• What is Mark’s overall mission with the work that he’s doing? [1:40:30];
  
• Bread in the US vs. Europe: Why does bread (and wheat products) taste different and potentially cause less health problems in Europe versus the US? [1:42:00]; and
  
• More.
  

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/markhyman

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Today's episode of The Qualys is from podcast #34 – Sam Harris, Ph.D.: The transformative power of mindfulness.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ 

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In my first interview with Jason Fried, Jason explained his overall philosophy about work-life balance and how exactly he optimizes for efficiency. For this special follow-up AMA, we've decided to release the full episode to everyone (including non-subscribers), so all can hear Jason answer questions from listeners that dive deeper into topics such as work-life balance, the role of luck versus hard work in success, specifics around Basecamp’s unique process-oriented approach to projects, 4-day work weeks, practical tips for people searching for the right company culture, tips on writing and parenting, and a whole bunch more.

• If Jason had taken his own advice about work-life balance at the start of his career, would he have achieved the same level of success? [2:05];

• What is Jason’s definition of success, and what is he optimizing for? [10:10];

• Basecamp’s policy on email and expectations for a quick response, and why Jason believes in sleeping on big decisions [14:30];

• How Jason implements “true” work-life balance in his life and at Basecamp [19:15];

• Does work and life have to be separated in order to have balance? [32:00];

• How Jason makes time the fixed component to avoid the compulsion to keep pushing forward on a project perpetually [34:15];

• Jason’s tip for physicians who may be facing burnout [45:00];

• Signs of “burnout” if you do the same thing for work and pleasure, and tips to avoid and manage that feeling [49:45];

• Is a 40-hour work week the correct amount? [53:45];

• How to evaluate a company’s culture when looking for a job with the right work environment [59:00];

• Jason’s take on salaries and alternate incentives like equity, profit sharing, etc. [1:06:45];

• What traits does Jason look for when hiring new employees? [1:13:45];

• Does Jason believe in process-oriented work or outcome-driven work, and Basecamp’s unique process for completing projects [1:16:15];

• How does Jason handle a project that results in a failure? [1:20:00];

• Advice for people in situations where they don’t have full control of their time and work demands [1:23:50];

• How much of success should be attributed to skill versus luck? [1:29:30];

• The importance of writing skills, and tip to improve your writing [1:43:15];

• Lessons learned from parenting, and Peter’s top priority when it comes to raising kids [1:52:15];

• An important skill: the ability to say “no” to things [2:01:15]; and

• More.

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/jasonfriedama

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Today's episode of The Qualys is from podcast #04 – AMA #1: alcohol, best lab tests, wearables, finding the right doc, racing, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

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In this “Ask Me Anything” (AMA) episode, Peter explains the various levers one can pull to affect longevity with a specific focus on the strategies and tactics one can implement that do not require the help of a physician. Once again, Bob Kaplan, Peter's head of research, will be asking the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA.

If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #12 show notes page.

We discuss:

• The five levers you can pull to affect longevity [1:15];

• Nutritional biochemistry: Framework, 3 nutritional interventions, and how to approach your goals, and what you should be tracking [4:30];

• Exercise for brain health, and the 4 components of exercise [20:45];

• Exercise component—Stability [24:30];

• Exercise component—Strength [29:00];

• What is Peter optimizing for with his exercise? [30:30];

• Exercise components—Zone 2 and zone 5 training [33:15];

• More about DNS, and why we need to be careful with rushing kids through neuromuscular development stages [45:00];

• Sleep: How to improve quantity and quality [48:15]; and

• More.

Learn more: https://peterattiamd.com/

Show notes page for this episode:  https://peterattiamd.com/AMA12

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Today's episode of The Qualys is from podcast #03 – Ron Krauss, M.D.: a deep dive into heart disease.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ 

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In this episode, Dr. Eric Topol, founder and director of the Scripps Research Translational Institute, shares how artificial intelligence and deep learning is currently impacting medicine and how it could transform the healthcare industry, not only in terms of the technological advancements, but also in restoring the patient-doctor relationship for better patient outcomes and experiences. We also discuss Eric’s rich and fascinating career in cardiology as well as his involvement as one of the first outspoken researchers to question the cardiovascular safety of Vioxx.

We discuss:

• Eric’s background and his source of interest in cardiology [3:15];
  
• The US medical field’s resistance to technological change and learning from other healthcare models [11:15];
  
• Eric’s mission at the Cleveland Clinic [20:15];
  
• How Eric helped to elucidate the issues with Vioxx (and why he came to regret it) [29:45];
  
• How Eric came to found one of the most influential research centers in the world [47:30];
  
• How AI and deep learning is currently impacting medicine, and the future possibilities [56:30];
  
• Gut microbiome—Its role in health, impact on glycemic response and fuel partitioning, and how deep learning could improve our research and treatment [1:17:45];
  
• Why machines combined with human doctors is superior to one without the other [1:32:00];
  
• How AI and machines can reinstate medicine as an attractive career (and alleviate physician burnout) [1:36:45];
  
• Eric’s dream experiment [1:47:15] and;
  
• More.

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/erictopol

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Today's episode of The Qualys is from podcast #14 – Robert Lustig, M.D., M.S.L.: fructose, processed food, NAFLD, and changing the food system.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ 

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In this episode, Ryan Holiday, author of Stillness is the Key, shares the profound impact that stoic philosophy has had on his personal life and his career as a successful writer. Ryan stresses the importance of stillness in a modern world set up to encourage the opposite and lays out the best strategies to develop stillness in your life. He also explains the destructive nature of being driven by ego, as well as the perils of jealousy and anger, and provides practical steps you can take to avoid those harmful states.

We discuss:

• Has a more connected world improved or worsened our lives? [2:15];
  
• Consequences of an overly secure life, living in the present, & the misconception of unlimited time [5:45];
  
• Stoicism 101: The definition and origins of stoic philosophy [15:45];
  
• Ryan’s career transition into writing, and his take on what makes a book or business successful [26:45];
  
• Storytelling—The upside and downside of telling stories and self-narrative [36:15];
• Does achieving success have to come from a place of craving and proving others wrong? And what are the costs of building a legacy? [38:45];
  
• Ego—confusing ego with confidence, signs your ego is showing, & antidotes to the negative effects of ego [52:45];
  
• Ryan’s advice to Peter about writing (and finishing) his book [1:06:30];
  
• Stillness—what it is, how it compares to meditation, & the obstacles to achieving stillness [1:10:30];
  
• Ryan’s morning routine, relationship with his smartphone, and how he avoids falling victim to the trappings of technology and a hyperconnected world [1:17:40];
  
• The perils of jealousy and envy [1:24:15];
  
• How to live in the moment in a modern world not designed for stillness [1:32:15];
  
• How the idea of “dying well” can help you live better [1:36:00];
  
• How has fatherhood impacted Ryan’s philosophies on stillness and living in the moment? [1:39:45];
  
• How to make your favorite day your every day [1:42:00];
  
• The most reliable strategies for developing stillness [1:47:30];
  
• Anger—what the stoics say about anger, outrage in politics, & why more anger isn’t the solution [2:02:00];
  
• How to follow Ryan’s work [2:12:00]; and
  
• More.
  

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Show notes page for this episode: https://peterattiamd.com/ryanholiday

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Today's episode of The Qualys is from podcast #28 – Mark and Chris Bell: steroids, powerlifting, addiction, diet, training, helping others, documentaries, and living your best life.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

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In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of fasting-specific questions from subscribers. Peter starts by defining the various fasting protocols, details his own personal fasting regimen, explains his revised plan for 2020, and provides a ton of value to anyone interested in fasting. Once again, Bob Kaplan, Peter's head of research, will be asking the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA.

If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #11 show notes page.

We discuss:

• Defining the various fasting protocols [1:00];
  
• Why Peter plans to switch to a 3-day fast once per month in 2020 [11:00];
  
• How Peter uses his CGM to gain insights into the depth of fast [13:15];
  
• Peter’s supplement protocol during fasting, and why he eats a ketogenic diet leading up to a prolonged fast [17:00];
  
• Peter’s exercise regimen during a fast [23:30];
  
• Peter’s hunger levels during a typical 7-day fast [26:45];
  
• Fasting observations—Core body temperature and thyroid hormone [30:30];
  
• Fasting observations—Glucose, BHB, and hunger levels [33:15];
  
• Peter’s sleep protocol during a fast [40:15];
  
• Does Peter observe any differences between men and women in their ability to fast? [47:00];
  
• How Peter prefers to break a long fast [50:15];
  
• Importance of community support while fasting, and is there a perfect fasting protocol? [52:00]; and
  
• More.
  

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/ama11/

Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/

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Today's episode of The Qualys is from podcast #34 – Sam Harris, Ph.D.: The transformative power of mindfulness.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ 

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD 

In this episode, Paul Grewal, internal medicine physician and co-author of Genius Foods, discusses what has got him so focused on lifestyle changes for metabolic health which was partly brought on by his own experience of losing almost 100 pounds at two points in his life. Paul and Peter discuss how the results from a NuSI-funded study has impacted their feelings about the supposed “metabolic advantage” of a low-carb diet. Paul then makes the case for what he calls the “active poisoning” of the American food supply, defines his five phenotypes of obesity manifestation, as well as lays out his nutritional and training approach with his patients (as well as himself personally). Overall, this discussion is a treasure trove of topics from endocrinology, insulin resistance, caloric restriction, fasting, exercise, causes of obesity, LDL and heart disease, and much more.

We discuss:

• Paul’s health story—two instances of major weight loss [3:15];
  
• The multiplication of adipocytes after weight loss, and why an obese adult that was overweight in childhood is harder to treat than adult-onset obesity [7:30];
  
• Low-carb diets—Is there a metabolic advantage in energy expenditure? (And Peter’s take on the NUSI study) [12:45];
• The relationship between hyperinsulinemia and hyperglycemia—which is causing which? [27:00];
  
• Weight gain—Which macronutrients are driving it, processed foods, and overfeeding studies [31:15];
  
• The active poisoning of our food supply with processed foods [36:15];
  
• The role of fructose in metabolic disease and NAFLD [39:00];
  
• Where traditional medicine falls short in the real world and why “functional medicine” is gaining steam [45:45];
  
• Relationship between heart disease and LDL, residual risk, LDL clearance problem, and a patient case study [54:00];
  
• Relationship between heart disease and fatty acids (SFA, PUFA, seed oils, etc.) [1:04:30];
  
• Paul’s nutritional approach with patients [1:12:30];
  
• High-carb/low-fat diet for muscle gain, and the “reverse diet” to combat the slowdown of metabolism after caloric restriction/weight loss [1:15:00];
  
• Fasting—ideal duration, how to preserve muscle mass, and the ultimate tool of medicine [1:23:30];
  
• The 5 phenotypes of obesity, and the impact of carbs, cortisol, and sleep on adiposity [1:28:30];
  
• Uric acid [1:38:15];
  
• Paul’s 2nd big physical transformation—How he did it and kept the weight off [1:39:15];
  
• Paul and Peter’s personal struggles with food, internal dialogue, and self-image [1:45:00];
  
• Paul’s personal nutritional strategy (and how his exercise influences it) [1:52:00];
  
• A low-fat diet Peter is willing to try [2:00:40];
• The keto diet for competitive athletes [2:05:00];
  
• How Peter prescribes exercise to his patients [2:08:30];
  
• Calculating glycogen depletion and RQ, creatinine-kinase system, Tabata workouts, and more [2:10:30]; and
  
• More.