The Peter Attia Drive

By Peter Attia, MD

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Subscribers: 4562
Reviews: 7


 Apr 20, 2022

Rob
 Mar 29, 2020

Joe M
 Jul 20, 2019
Has risen through the ranks to become my favorite podcast, I get excited when I see a new episode come out. Such a thoughtful and thought filled podcast I always learn something new even if a lot of the medical ones are a bit over my head.


 Jul 10, 2019


 Jun 19, 2019

Description

Expert insight on health, performance, longevity, critical thinking, and pursuing excellence. Dr. Peter Attia (Stanford/Hopkins/NIH-trained MD) talks with leaders in their fields.

Episode Date
Earning the gift of life | Ric Elias (#79 rebroadcast)
01:39:59

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

We discuss: 

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

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Jul 04, 2022
#212 - The neuroscience of obesity | Stephan Guyenet, Ph.D.
02:24:59

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

We discuss:

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

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Jun 27, 2022
#211 - AMA #36: Fruits & vegetables—everything you need to know
20:22

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

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

We discuss:

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

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Jun 20, 2022
#210 - Lp(a) and its impact on heart disease | Benoît Arsenault, Ph.D.
02:07:18

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

We discuss:

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

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Jun 13, 2022
#209 ‒ Medical mistakes, patient safety, and the RaDonda Vaught case | Marty Makary, M.D., M.P.H.
01:45:27

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

We discuss:

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

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Jun 06, 2022
The Art of Stability | Beth Lewis (Ep. #131 Rebroadcast)
01:48:36

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

We discuss:

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

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May 30, 2022
#208 - Tragedy, grief, healing, and finding happiness | Kelsey Chittick
01:54:37

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

We discuss:

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

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May 23, 2022
#207 - AMA #35: "Anti-Aging" Drugs — NAD+, metformin, & rapamycin
30:32

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

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

We discuss:

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

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May 16, 2022
#206 - Exercising for longevity: strength, stability, zone 2, zone 5, and more
01:14:02

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

We discuss:

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

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May 09, 2022
#205 - Energy balance, nutrition, & building muscle | Layne Norton, Ph.D. (Pt.2)
02:55:43

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

We discuss:

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

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May 02, 2022
#204 - Centenarians, metformin, and longevity | Nir Barzilai, M.D.
02:29:33

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

We discuss:

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

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Apr 25, 2022
#203 - AMA #34: What Causes Heart Disease?
16:59

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

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

We discuss:

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

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Apr 18, 2022
#202 - Peter on nutrition, disease prevention, sleep, and more — looking back on the last 100 episodes
01:57:28

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

We discuss:

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

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Apr 11, 2022
In remembrance of Sarah Hallberg, D.O., M.S. (Ep. #162 Rebroadcast)
02:17:24

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Episode Description:

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

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

We discuss:

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

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Apr 04, 2022
#201 - Deep dive back into Zone 2 | Iñigo San-Millán, Ph.D. (Pt. 2)
02:45:31

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Episode Description:

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

We discuss:

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

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Mar 28, 2022
#200 - AMA #33: Hydration—electrolytes, supplements, sports drinks, performance effects, and more
19:23

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Episode Description:

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

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

We discuss:

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

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Mar 21, 2022
#199 - Running, overcoming challenges, and finding success | Ryan Hall
02:55:54

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Episode Description:

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

We discuss:

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

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Mar 14, 2022
#198 - Eye health—everything you need to know | Steven Dell, M.D.
02:43:41

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Episode Description:

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

We discuss:

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

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Mar 07, 2022
#197 - The science of obesity & how to improve nutritional epidemiology | David Allison, Ph.D.
02:14:14

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Episode Description:

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

We discuss:

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

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Feb 28, 2022
#196 - AMA #32: Exercise, squats, deadlifts, BFR, and TRT
19:12

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Episode Description:

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

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

We discuss:

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

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Feb 21, 2022
#195 - Freedom, PTSD, war, and life through an evolutionary lens | Sebastian Junger
02:57:01

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Episode Description:

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

 

We discuss:

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

 

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Feb 14, 2022
#194 - How fructose drives metabolic disease | Rick Johnson, M.D.
02:05:28

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Episode Description:

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

We discuss:

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

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Feb 07, 2022
#193 - AMA #31: Heart rate variability (HRV), alcohol, sleep, and more
13:41

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Episode Description:

 

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

 

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

 

We discuss:

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

 

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Jan 31, 2022
#192 - COVID Part 2: Masks, long COVID, boosters, mandates, treatments, and more
02:52:48

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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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Jan 24, 2022
#191 - Revolutionizing our understanding of mental illness with optogenetics | Karl Deisseroth M.D., Ph.D.
02:29:23

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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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Jan 17, 2022
#190 - Paul Conti, M.D.: How to heal from trauma and break the cycle of shame
02:20:58

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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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Jan 10, 2022
#189 - COVID-19: Current state of affairs, Omicron, and a search for the end game
02:45:14

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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Jan 03, 2022
Iñigo San Millán, Ph.D.: Zone 2 Training and Metabolic Health (Ep. #85 Rebroadcast)
02:50:56

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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Dec 27, 2021
#188 - AMA #30: How to Read and Understand Scientific Studies
30:07

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.
Dec 20, 2021
#187 - Sam Apple: The Warburg Effect—Otto Warburg’s cancer metabolism theory
01:48:22

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
Dec 13, 2021
#186 - Patrick Radden Keefe: The opioid crisis—origin, guilty parties, and the difficult path forward
01:55:56

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

We discuss:

  • Patrick’s investigation into distribution and use of drugs in our society [3:55];
  • The scale of the opioid crisis [9:15];
  • The Sackler brothers: family life, career in the pharmaceutical industry, and role in the current crisis [11:45];
  • Purdue Pharma: origins, early years, and move towards pain management drugs [17:30];
  • The development of OxyContin: its conception, marketing, and the controversy around the FDA approval process [25:30];
  • Early reports of OxyContin addiction and unintended consequences and how Purdue Pharma sidestepped responsibility [40:45];
  • The many paths to addiction and abuse of OxyContin and the ensuing downfall of Purdue Pharma [47:15];
  • Peter’s personal experience with OxyContin [57:00];
  • Pain—the “fifth vital sign,” how doctors are trained in pain management, and the influence of money [1:08:00];
  • Other players that helped facilitate the eventual opioid crisis [1:16:15];
  • Lack of accountability following the investigation and prosecution of Purdue and the Sackler family [1:23:30];
  • Legacy of the Sackler family and their disconnect from reality [1:34:45];
  • Patrick’s views on the regulation and use of pain management drugs [1:42:15];
  • The difficult path forward [1:44:45]; and
  • More.
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Dec 06, 2021
#185 - Allan Sniderman, M.D.: Cardiovascular disease and why we should change the way we assess risk
02:02:13

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

We discuss:

  • Problems with the current 10-year risk assessment of cardiovascular disease (CVD) and the implications for prevention [4:30];
  • A primer on cholesterol, apoB, and plasma lipoproteins [16:30];
  • Pathophysiology of CVD and the impact of particle cholesterol concentration vs. number of particles [23:45];
  • Limitations of standard blood panels [29:00];
  • Remnant type III hyperlipoproteinemia—high cholesterol, low Apo B, high triglyceride [32:15];
  • Using apoB to estimate risk of CVD [37:30];
  • How Mendelian randomization is bolstering the case for ApoB as the superior metric for risk prediction [40:45];
  • Hypertension and CVD risk [49:15];
  • Factors influencing the decision to begin preventative intervention for CVD [58:30];
  • Using the coronary artery calcium (CAC) score as a predictive tool [1:03:15];
  • The challenge of motivating individuals to take early interventions [1:12:30];
  • How medical advancement is hindered by the lack of critical thinking once a “consensus” is reached [1:15:15];
  • PSK9 inhibitors and familial hypercholesterolemia: two examples of complex topics with differing interpretations of the science [1:20:45];
  • Defining risk and uncertainty in the guidelines [1:26:00];
  • Making clinical decisions in the face of uncertainty [1:31:00];
  • How the emphasis on consensus and unanimity has become a crucial weakness for science and medicine [1:35:45];
  • Factors holding back the advancement of apoB for assessing CVD risk, treatment, and prevention strategies [1:41:45];
  • Advantages of a 30-year risk assessment and early intervention [1:50:30];
  • More.
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Nov 29, 2021
Rick Johnson, M.D.: Metabolic Effects of Fructose (Ep. #87 Rebroadcast)
01:49:48

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

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

We discuss:

  • The connection between blood pressure and fructose that shifted Rick’s professional focus [3:00];
  • The relationship between salt and blood pressure (and the role of sugar) [4:45];
  • Defining fructose, glucose, and sugar [18:30];
  • An ancient mutation in apes that explains why humans turn fructose into fat so easily [22:00];
  • The problems with elevated uric acid levels, and what it tells us about how sugar causes disease [30:30];
  • How sugar causes obesity—explaining the difference in glucose vs. fructose metabolism and the critical pathway induced by fructose [39:00];
  • Why drinking sugar is worse than eating it [49:00];
  • Unique ability of sugar to drive oxidative stress to the mitochondria, insulin resistance, and diabetes [53:00];
  • Why cancer loves fructose [59:20];
  • The many areas of the body that can use fructose [1:04:00];
  • Fructokinase inhibitors—a potential blockbuster? [1:06:15];
  • Treating high uric acid levels—Rick’s approach with patients [1:09:00];
  • Salt intake—what advice does Rick give his patients? [1:15:30];
  • How excess glucose (i.e., high carb diets) can cause problems even in the absence of fructose [1:20:00];
  • Artificial sweeteners vs. real sugar—which is better? [1:28:15];
  • Umami, MSG, alcohol, beer—do these have a role in metabolic illness? [1:32:45];
  • Fructose consumption—Is any amount acceptable? Is fruit okay? Where does Rick draw a hard line? [1:37:45]
  • How does Rick manage the sugar intake of his young kids? [1:42:00]; and
  • More.
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Nov 22, 2021
#184 - AMA #29: GLP-1 Agonists—The Future of Treating Obesity?
14:19

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

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

We discuss:

  • Remarkable results of a recent study in overweight adults [2:15];
  • Key background on insulin, glucagon and the incretin effect [4:00];
  • What is GLP-1 and how does it work? [16:30];
  • 2021 semaglutide study: remarkable results, side effects, and open questions [30:00];
  • Semaglutide vs. lifestyle interventions: comparing results with semaglutide vs. lifestyle interventions alone [44:00];
  • Closing thoughts and open questions on the therapeutic potential of semaglutide [47:30]; and
  • More
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Nov 15, 2021
#183 - James Clear: Building & changing habits
02:18:49

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

We discuss:

  • Why James became deeply interested in habits [1:45];
  • Viewing habits through an evolutionary lens [6:00];
  • The power of immediate feedback for behavior change, and why we tend to repeat bad habits [9:15];
  • The role of genetics and innate predispositions in determining one’s work ethic and success in a given discipline [14:30];
  • How finding one’s passion can cultivate perseverance and discipline [23:15];
  • Advantages of creating systems and not just setting goals [29:15];
  • The power of habits combined with self-identity to induce change [36:30];
  • How a big environmental change or life event can bring on radical behavioral change [50:30];
  • The influence of one’s social environment on their habits [54:15];
  • How and why habits are formed [1:00:30];
  • How to make or break a habit with the “Four Laws of Behavior Change” [1:09:30];
  • Practical tips for successful behavioral change—the best strategies when starting out [1:16:15];
  • Self-forgiveness and getting back on track immediately after slipping up [1:30:30];
  • Law #1: Make it obvious—strategies for identifying and creating cues to make and break habits [1:39:45];
  • Law #2: Make it attractive—ways to make a new behavior more attractive [1:47:45];
  • Law #3: Make it easy—the 2-minute rule [1:58:45];
  • Law #4: Make it satisfying—rewards and reinforcement [2:03:30];
  • Advice for helping others to make behavioral changes [2:06:00];
  • More.
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Nov 08, 2021
#182 - David Nutt: Psychedelics & Recreational Drugs
01:38:44

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

We discuss:

  • David’s early interest in the brain and experience in psychiatry [2:45];
  • David’s brief work on government drug policy in the UK [10:15];
  • A scale for rating the relative harm of certain drugs [13:45];
  • The contrast in regulation between cannabis vs. alcohol and why research on potential benefits of cannabis is lacking [19:15];
  • The opiate crisis and rise of fentanyl: the cause and potential solution [25:00];
  • The science of addiction and the potential use of psychedelics for treating drug addiction [35:00];
  • Cocaine: mechanisms of action and risks [41:45];
  • Methamphetamine and crystal meth: mechanisms of action and neurotoxicity [48:15];
  • How psychedelics came to be classified as schedule I drugs despite their numerous therapeutic uses [52:45];
  • The history of MDMA and the bad science and political forces leading to its demonization [1:08:45];
  • History of ketamine, medical use of esketamine, and the waning effects of psychedelics with increasing usage [1:13:30];
  • Psilocybin for depression: David’s promising research and the roadblocks to more robust experiments [1:20:15];
    More.
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Nov 01, 2021
#181 - Robert Gatenby, M.D.: Viewing cancer through an evolutionary lens and why this offers a radically different approach to treatment
01:59:40

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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Oct 25, 2021
#180 - AMA #28: All things testosterone and testosterone replacement therapy
20:37

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

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

We discuss:

  • A primer on the hormone testosterone and how it influences gene expression [3:30];
  • How the body naturally regulates testosterone levels [11:30];
  • The defining threshold for "low testosterone," how low T impacts men, and why free testosterone is the most important metric [16:15];
  • When it makes sense to treat low testosterone [26:00];
  • The structural and metabolic benefits of testosterone replacement therapy [29:15];
  • Body composition changes with TRT [45:30];
  • Changes in bone mineral density with TRT [48:15];
  • The metabolic impact of TRT: glucose, insulin, triglycerides, and more [52:30];
  • A study investigating testosterone replacement therapy for prevention or reversal of type 2 diabetes [59:30];
  • The impact of TRT on metabolic parameters and body composition—A study comparing results from continuous vs. interrupted treatment [1:07:15]
  • The controversy over TRT and cardiovascular disease [1:21:45];
  • Two flawed studies that shaped perceptions of risks associated with TRT [1:44:15];
  • The controversy over TRT and prostate cancer [1:56:45];
  • Other potential risks with testosterone replacement therapy [2:02:15]; and
  • More
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Oct 18, 2021
#179 - Jeremy Loenneke, Ph.D.: The science of blood flow restriction—benefits, uses, and what it teaches us about the relationship between muscle size and strength
01:59:25

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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Oct 11, 2021
#178 - Lance Armstrong: The rise, fall, and growth of a cycling legend
01:58:16

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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Oct 04, 2021
#177 - Steven Rosenberg, M.D., Ph.D.: The development of cancer immunotherapy and its promise for treating advanced cancers
02:06:26

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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Sep 27, 2021
#176 - AMA #27: The importance of muscle mass, strength, and cardiorespiratory fitness for longevity
18:56

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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Sep 20, 2021
#175 - Matt Kaeberlein, Ph.D.: The biology of aging, rapamycin, and other interventions that target the aging process
02:40:39

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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Sep 13, 2021
#174 - Lawrence Wright: The 20th anniversary of the 9/11 attacks: reflections on how they happened, and lessons learned and not learned
03:01:55

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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Sep 06, 2021
#173 - AMA #26: Continuous glucose monitors, zone 2 training, and a framework for interventions
19:39

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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Aug 23, 2021
#172 - Esther Perel: The effects of trauma, the role of narratives in shaping our worldview, and why we need to accept uncomfortable emotions
02:04:13
Esther Perel is a psychotherapist and New York Times bestselling author who is an expert on modern relationships. In this episode, Esther describes how being a child of parents who narrowly survived the Holocaust shaped and influenced her perspectives and ultimately led to her to a career in therapy. She discusses how the generational differences in parenting, among other things, led to the rise of individualism with a focus on happiness and self-esteem to the detriment of our relationships and sense of community. Ultimately, the conversation focuses on the value of our relationships with others for one’s sense of wellbeing, ability to deal with past trauma, resilience, and even our lifespan. She uses real world case studies to emphasize the therapeutic value of creating healthy relationships with others and oneself, explaining how our relationships with others can be a mirror into our own maladaptive behaviors. Esther explains how our self-narratives, which are often shaped by past trauma, may negatively impact our relationships with others and our emotional health, and emphasizes the value in trying to change them when warranted.

 

We discuss:

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

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Aug 16, 2021
#171 - Steve Austad, Ph.D.: The landscape of longevity science: making sense of caloric restriction, biomarkers of aging, and possible geroprotective molecules
02:26:54

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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Aug 09, 2021
#170 - AMA #25: Navigating the complexities and nuances of cancer screening
12:28

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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Jul 26, 2021
#169 - Katherine Eban: COVID-19 Lab Leak: Examining all sides of the debate and discussing barriers to a full investigation
01:39:43

 

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

 

We discuss:

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

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Jul 19, 2021
#168 - Hugh Jackman: Reflections on acting, identity, personal transformation, and the significance of being Wolverine
02:09:56

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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Jul 12, 2021
#167 - Gary Taubes: Bad science and challenging the conventional wisdom of obesity
02:36:49

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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Jun 28, 2021
#166 - Patricia Corby, D.D.S.: Importance of oral health, best hygiene practices, and the relationship between poor oral health and systemic disease
02:00:37

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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Jun 21, 2021
#165 - AMA #24: Deep dive into blood glucose: why it matters, important metrics to track, and superior insights from a CGM
17:22

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

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

 

We discuss:

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

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Jun 14, 2021
#164 - Amanda Smith, M.D.: Diagnosing, preventing, and treating Alzheimer’s disease, and what we can all learn from patients with dementia
02:01:48
Amanda Grant Smith is a geriatric psychiatrist with decades of experience treating patients with dementia and Alzheimer's disease. In this episode, Amanda shares how she developed a passion for geriatric psychiatry as a means to support dementia patients. She explains how to recognize, define, and diagnose dementia—a process that still remains somewhat elusive. They also talk about the significance of ApoE genotype and compare the various forms of dementia including differentiating between Alzheimer’s disease and Lewy body dementia. They discuss the current landscape of clinical trials, the drug pipeline, and talk about a very promising monoclonal antibody directed at amyloid beta that has the potential to be a disease-modifying drug. They conclude with a discussion about how to define “healthy aging” and reflect on how understanding dementia can shape one’s life philosophy.

 

We discuss:

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

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Jun 07, 2021
#163 - Layne Norton, Ph.D.: Building muscle, losing fat, and the importance of resistance training
02:41:10
Layne Norton is a physique coach, a natural professional bodybuilder and powerlifter, and holds a Ph.D. in nutritional sciences. In this episode, Layne explains how he became interested in weightlifting and fitness both professional and academically. He provides insights into preventing and managing injuries while using consistency and determination to boost his professional success in bodybuilding and powerlifting. Peter and Layne also review the science of body composition and what’s really driving muscle growth, including the role of nutrition, supplements, and a number of important and misunderstood hormones important to muscle protein synthesis. Furthermore, Layne stresses the importance of maintaining muscle mass even while losing fat for improving metabolic health and longevity and provides the keys to developing healthy habits. 

 

We discuss:

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

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May 24, 2021
#162 - Sarah Hallberg, D.O., M.S.: Challenging the status quo of treating metabolic disease, and a personal journey through a grim cancer diagnosis
02:21:28
Sarah Hallberg is the Medical Director at Virta Health and a physician who has spent nearly two decades treating patients with obesity and type 2 diabetes. In the first half of this episode, Sarah discusses how she became a huge believer in the efficacy of carbohydrate restriction for the treatment of type 2 diabetes through her research and clinical experience. Sarah challenges the common beliefs about the role of dietary fat and carbohydrate on the plasma makeup of fatty acids and triglycerides. She also expresses the importance of understanding early predictors of metabolic illness—highlighting one particular fatty acid as the most important early predictor—before finishing with a discussion about how doctors might be able to personalize patients’ metabolic management in the future. In the second half of this episode, Sarah tells the personal story of her own lung cancer diagnosis. She talks about dealing with her grief, deciding to continue her work while prioritizing her family, and how she devised a plan to extend her survival as long as possible.  

 

We discuss:

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

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May 17, 2021
#161 - AMA #23: All Things Nicotine: deep dive into its cognitive and physical benefits, risks, and mechanisms of action
19:53

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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May 10, 2021
#160 - Paul Offit, M.D.: The latest on COVID-19 vaccines and their safety, herd immunity, and viral variants
01:25:39

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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May 03, 2021
#159 - Peter Hotez, M.D., Ph.D.: Evolution of the anti-vaccine movement, the causes of autism, and COVID-19 vaccine state of affairs
01:54:36

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

 

We discuss:

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

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Apr 26, 2021
#158 - Brian Deer: A tale of scientific fraud—exposing Andrew Wakefield and the origin of the belief that vaccines cause autism
01:49:38
Brian Deer is an award-winning investigative journalist best known for his coverage of the pharmaceutical industry. In this episode, he and Peter discuss the content of his book, The Doctor Who Fooled the World: Science, Deception, and the War on Vaccines, which exposes the complex and disturbing story behind the infamous 1998 Lancet paper by Andrew Wakefield linking the MMR vaccine and autism. Brian explains how doctors led by Wakefield, a lawyer, and an anti-vaccination parents’ group worked together on a study to validate their preconceived belief that the MMR vaccine caused autism. He reveals what happened behind the scenes as the study was carried out, explains problems in the lab, and discusses inconsistencies in the analysis.  In the end, this is a story that serves as a cautionary tale about the consequences of science driven by an agenda rather than by a spirit of open inquiry.

 

We discuss:

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

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Apr 19, 2021
#157 - AMA #22: Losing fat and gaining fat: the lessons of fat flux
15:25
In this “Ask Me Anything” (AMA) episode, Peter and Bob take a deep dive into fat flux. They define the major players that impact the flow of fat entering and exiting a fat cell, which determines how much fat a person carries. They discuss the significant influence that insulin has on the net fat balance and explore common strategies, such as fasting and low-carb diets, that have efficacy in the liberation and oxidation of fat from fat cells. Additionally, Bob explains his research process and how he seeks answers to Peter’s challenging questions.
 

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

 

We discuss:

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

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Apr 12, 2021
#156 - Jake Muise: Humanely harvesting axis deer while alleviating its impact on Hawaii’s vulnerable ecosystems
02:19:52
Jake Muise is an avid hunter, environmentalist, and advocate for the preservation of Hawaii’s natural resources. He is the founder of Maui Nui Venison, a company which actively manages Hawaii’s imbalanced population of axis deer by harvesting them as a food resource. In this episode, Jake tells his unbelievable backstory growing up in Northern Alberta before landing in Hawaii on a volleyball scholarship where he fell in love with the islands and the people. Jake explains how axis deer—a non-native species—were brought to the islands and how they have since become imbalanced to the detriment of Hawaii’s precious ecosystems. He goes on to explain the incredible lengths that his company has taken to ensure the most humane harvesting techniques imaginable resulting in a food source that is as clean and healthful as can be. Additionally, Jake and Peter examine what makes meat from axis deer one of the most nutrient-dense red meats on the planet.

 

We discuss:

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

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Apr 05, 2021
#155 - Chris Sonnenday, M.D.: The history, challenges, and gift of organ transplantation
02:14:33
Chris Sonnenday is the Transplant Center Director for Michigan Medicine. As Peter’s senior resident while at Johns Hopkins, Chris made a lasting impression on him with his remarkable leadership and ability to maintain his humanity through the stressors of that challenging environment. In this episode, Chris tells the incredible backstory of the history of transplant medicine, focusing on the kidney and the liver. He discusses the surgical and immunologic developments that launched the field forward, but also lays out the challenges ahead for the field, such as the rising prevalence of chronic kidney and liver failure. Chris also tells many stories of tragedy and triumph that comes with working in organ transplantation, but ultimately explains the rewarding nature of being a witness to the gift of organ donation.

 

We discuss:

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

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Mar 29, 2021
#154 - Steve Levitt, Ph.D.: A rogue economist’s view on climate change, mental health, the ethics of experiments, and more
02:00:19
Steven Levitt is a professor of economics at the University of Chicago and the co-author of the bestselling book Freakonomics and its two sequels. In this episode, Steve discusses his unlikely path to a career in economics and his view of the current state, and limitations, of the field. He also gives his unique perspective on contemporary issues including climate change, mental health in education, how to evaluate whether an experiment is ethical, decision making, horse racing, and much more. 

 

We discuss:

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

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Mar 22, 2021
#153 - AMA #21: Deep dive into olive oil, high-intensity exercise, book update, and more
14:02
In this “Ask Me Anything” (AMA) episode, Peter and Bob take a deep dive into olive oil. They explore the history of olive oil, discuss observational data that led to the hypothesis that olive oil is a healthier alternative to many other fats, and they explain the classification of olive oil types —including what to look for in a high-quality “extra virgin” olive oil. Peter and Bob round out the discussion with a “two-minute drill,” in which Peter answers questions from subscribers. They cover zone 5 training, an update on Peter’s book, lactate meters, standing desks, massage guns, electrolyte supplementation, and more. 

 

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

 

We discuss:

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

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Mar 15, 2021
#152 - Michael Rintala, D.C.: Principles of Dynamic Neuromuscular Stabilization (DNS)
01:35:34

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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Mar 08, 2021
#151 - Alex Hutchinson, Ph.D.: Translating the science of endurance and extreme human performance
02:13:44

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

 

We discuss:

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

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Mar 01, 2021
#150 - Senator Bill Frist, M.D.: A modern Renaissance man's journey through science, politics, and business
02:23:38

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

We discuss:

  • Bill’s decision to pursue medicine and do organ transplants (3:40);
  • The miraculous nature of organ transplants: History, Bill’s work, and the most exciting things to come (12:00);
  • Frist’s experience building up the heart transplant program at Vanderbilt (21:45);
  • The famous rivalry between surgeons Denton Cooley and Michael DeBakey (29:15);
  • How the medical field can attract bright young people to pursue medicine (33:00);
  • Bill’s decision to leave medicine and run for the US senate (38:00);
  • The value in having scientists and physicians in Congress (47:30);
  • A discussion on whether or not senators should have term limits (55:30);
  • The highly polarized nature of politics, and how we can fix it with empathy (1:00:30);
  • Bill’s time in the Senate and quick rise to Senate Majority Leader (1:05:30);
  • The lifesaving impact of the President's Emergency Plan for AIDS Relief (PEPFAR) under George W. Bush (1:15:15);
  • How Bill reversed course on his view of the value and morality of stem cell research (1:19:45);
  • Complex end-of-life decisions, and Bill’s role in the infamous Terri Schiavo case—a story that captures the conflict among law, morality, and improving technology (1:30:00);
  • Remembering the events of September 11th from Bill’s perspective in the Senate (1:49:45);
  • The coronavirus pandemic: Bill’s accurate 2005 prediction, and a discussion about future preparedness (1:56:45);
  • The divided state of US politics, and how we can come together (2:06:45);
  • How experience in medicine and politics is shaping Bill’s current endeavors in business, reforming education, palliative care, and more (2:12:45); and
  • More.
 
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Feb 22, 2021
#149 - AMA #20: Simplifying the complexities of insulin resistance: how it's measured, how it manifests in the muscle and liver, and what we can do about it
23:07

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

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

We discuss:

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

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Feb 15, 2021
#148 - Richard Miller, M.D., Ph.D.: The gold standard for testing longevity drugs: the Interventions Testing Program
02:14:14
Richard Miller is a professor of pathology and the Director of the Center for Aging Research at the University of Michigan. He is one of the architects of the NIA-funded Interventions Testing Programs (ITPs) animal study test protocol. In this episode, Rich goes through the results of the long list of molecules tested by the ITP—including rapamycin, metformin, nicotinamide riboside, an SGLT-2 inhibitor called canagliflozin, and more. Many of the discussed outcomes have had surprising outcomes—both positive and negative findings.

We discuss:

  • Rich’s interest in aging, and how Hayflick’s hypothesis skewed aging research (3:45);
  • Dispelling the myth that aging can’t be slowed (15:00);
  • The Interventions Testing Program—A scientific framework for testing whether drugs extend lifespan in mice (29:00);
  • Testing aspirin in the first ITP cohort (38:45);
  • Rapamycin: results from ITP studies, dosing considerations, and what it tells us about early- vs. late-life interventions (44:45);
  • Acarbose as a potential longevity agent by virtue of its ability to block peak glucose levels (1:07:15);
  • Resveratrol: why it received so much attention as a longevity agent, and the takeaways from the negative results of the ITP study (1:15:45);
  • The value in negative findings: ITP studies of green tea extract, methylene blue, curcumin, and more (1:24:15);
  • 17α-Estradiol: lifespan effects in male mice, and sex-specific effects of different interventions (1:27:00);
  • Testing ursolic acid and hydrogen sulfide: rationale and preliminary results (1:33:15);
  • Canagliflozin (an SGLT2 inhibitor): exploring the impressive lifespan results in male mice (1:35:45);
  • The failure of metformin: reconciling negative results of the ITP with data in human studies (1:42:30);
  • Nicotinamide riboside: insights from the negative results of the ITP study (1:48:45);
  • The three most important takeaways from the ITP studies (1:55:30);
  • Philosophies on studying the aging process: best model organisms, when to start interventions, which questions to ask, and more (1:59:30);
  • Seven reasons why pigs can't fly (2:08:00); and
  • More.
 
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Feb 08, 2021
#147 - Hussein Yassine, M.D.: Deep dive into the “Alzheimer’s gene” (APOE), brain health, and omega-3s
02:06:19
Hussein Yassine is a physician and researcher who studies brain lipid utilization in the context of finding preventative measures for cognitive impairment, specifically Alzheimer’s disease (AD). In my conversation with Hussein, we begin with a fundamental coursework in brain biology—including its architecture and energy systems. We go on to discuss what these systems look like when something goes wrong and cognitive decline ensues. We talk about the evolutionary origins of the ApoE genotype, with specific attention to the ApoE4 allele and its association with AD. We spend time discussing ApoE4 implications for the brain’s fuel utilization, notably omega-3 fatty acids: EPA and DHA. We briefly pivot to the implications of recent omega-3 trials for cardiovascular disease and return to what we currently understand about EPA/DHA and brain health; we contemplate potential dietary interventions across the lifespan to preserve and prolong cognitive function.

We discuss:

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

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Feb 01, 2021
#146 - Guy Winch, Ph.D.: Emotional first aid and how to treat psychological injuries
01:57:29

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

We discuss:

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

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Jan 25, 2021
#145 - AMA #19: Deep dive on Zone 2 training, magnesium supplementation, and how to engage with your doctor
17:33
In this “Ask Me Anything” (AMA) episode, Peter and Bob take a deep dive into zone 2 training. They begin with a detailed definition of zone 2 and continue by discussing the importance of adding it to your exercise regimen. They talk about how to program zone 2 training, including intensity, frequency, and duration, and metrics for tracking improvement. Additionally, they provide a detailed overview of all things related to magnesium supplementation. The two conclude with insights about how to effectively engage with your doctor in the pursuit of getting your questions answered and considerations for finding a physician that’s right for you.

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

We discuss:

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

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Jan 18, 2021
#144 - Phil Maffetone: Optimizing health and performance through maximal aerobic function
01:22:12

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

 

We discuss:

 

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

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Jan 11, 2021
#143 - John Ioannidis, M.D., D.Sc.: Why most biomedical research is flawed, and how to improve it
01:52:01
John Ioannidis is a physician, scientist, writer, and a Stanford University professor who studies scientific research itself, a process known as meta-research. In this episode, John discusses his staggering finding that the majority of published research is actually incorrect. Using nutritional epidemiology as the poster child for irreproducible findings, John describes at length the factors that play into these false positive results and offers numerous insights into how science can course correct. 
 
We discuss:
  • John’s background, and the synergy of mathematics, science, and medicine (2:40);
  • Why most published research findings are false (10:00);
  • The bending of data to reach ‘statistical significance,’ and the how bias impacts results (19:30);
  • The problem of power: How over- and under-powered studies lead to false positives (26:00);
  • Contrasting nutritional epidemiology with genetics research (31:00);
  • How to improve nutritional epidemiology and get more answers on efficacy (38:45);
  • How pre-existing beliefs impact science (52:30);
  • The antidote to questionable research practices infected with bias and bad incentive structures (1:03:45);
  • The different roles of public, private, and philanthropic sectors in funding high-risk research that asks the important questions (1:12:00);
  • Case studies demonstrating the challenge of epidemiology and how even the best studies can have major flaws (1:21:30);
  • Results of John’s study looking at the seroprevalence of SARS-CoV-2, and the resulting vitriol revealing the challenge of doing science in a hyper-politicized environment (1:31:00);
  • John’s excitement about the future (1:47:45); and
  • More.

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Jan 04, 2021
#142 - Robert Abbott: The Bobby Knight story—a cautionary tale of unchecked anger, ego, and winning at all costs
02:14:25

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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Dec 21, 2020
#141 - AMA #18: Deep dive: sugar and sugar substitutes
16:18

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

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

We discuss:

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

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Dec 14, 2020
#140 - Gerald Shulman, M.D., Ph.D.: A masterclass on insulin resistance—molecular mechanisms and clinical implications
02:08:31
Gerald Shulman is a Professor of Medicine, Cellular & Molecular Physiology, and the Director of the Diabetes Research Center at Yale. His pioneering work on the use of advanced technologies to analyze metabolic flux within cells has greatly contributed to the understanding of insulin resistance and type 2 diabetes. In this episode, Gerald clarifies what insulin resistance means as it relates to the muscle and the liver, and the evolutionary reason for its existence. He goes into depth on mechanisms that lead to and resolve insulin resistance, like the role of diet, exercise, and pharmacological agents. As a bonus, Gerald concludes with insights into Metformin’s mechanism of action and its suitability as a longevity agent.

We discuss:

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

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Dec 07, 2020
#139 - Kristin Neff, Ph.D.: The power of self-compassion
01:16:34

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

We discuss:

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

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Nov 30, 2020
#138 - Lauren Miller Rogen and Richard Isaacson, M.D.: Alzheimer’s disease prevention—patient and doctor perspectives
02:11:39
Peter is joined by writer, director, actress, and founder of HFC, Lauren Miller Rogen, and previous podcast guest and director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian, Dr. Richard Isaacson. In this episode, Lauren tells the heartbreaking story of watching members of her family succumb to Alzheimer’s disease (AD) which motivated her to proactively address her own risk with Richard’s guidance. Richard discusses the various genetic and lifestyle factors that influence the risk of AD and uses Lauren’s unique situation to explain how he diagnoses patients and personalizes care. They go through Lauren’s protocol of preventative measures that have already produced marked results, and end with the uplifting message that one’s genetic predisposition does not seal one's fate.

We discuss:

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

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Nov 23, 2020
#137 - Paul Offit, M.D.: An expert perspective on COVID-19 vaccines
01:35:57
Paul Offit is a pediatrician specializing in infectious diseases and an expert in virology and vaccine development. He currently serves on the FDA committee overseeing and evaluating COVID-19 vaccines. In this episode, Paul discusses the strategies and major companies pursuing a vaccine against the SARS-CoV-2 virus. He gets into the nuances of the vaccine approval process and its implications for COVID-19 vaccine outlook. Paul also explains potential risks, reveals his own confidence level in safety, and gives insight into protection against reinfection with vaccination. Please note that this episode was recorded 11/05/2020, prior to the 11/09/2020 news release of the Pfizer vaccine update.
 
We discuss:
  • How Paul’s experience as a child in a chronic care hospital as child informed his path in pediatrics and vaccine development (3:30);
  • Addressing the anti-vaccination sentiment and explaining the fraudulent origins of the anti-vaccination movement (8:00);
  • Lessons and insights from 26 years studying rotavirus and creating a successful rotavirus vaccine (17:00);
  • Developing a new vaccine: the different phases of clinical trials, overall timeline, and financial costs (27:15);
  • Operation Warp Speed: the expedited process of creating a coronavirus vaccine (32:30);
  • Various vaccine strategies—RNA, DNA, virus vector—and the challenges associated (35:00);
  • The Moderna and Pfizer mRNA vaccines: strategy, timeline, and Emergency Use Authorization (41:15);
  • Paul’s confidence level in the safety of the first coronavirus vaccines (48:30);
  • The risks associated with different types of vaccines, and updates on the Johnson & Johnson and Astrazeneca coronavirus vaccines (52:15);
  • What we know about the coronavirus vaccines approved in Russia and China (55:45);
  • The latest on the Merck coronavirus vaccine (57:15);
  • The recombinant/purified protein vaccine approach for coronavirus—big players, risks, and the best vaccine for the elderly (57:45);
  • Attenuated and inactivated vaccine strategies for coronavirus (1:02:00);
  • The genetic drift of SARS-CoV-2: Impacts for protection and vaccine development (1:02:30);
  • Paul’s take on the hypothesis that a previous coronavirus infection offers protection against the novel COVID-19 (1:06:45);
  • Addressing the concern that antibodies fade over time (1:09:15);
  • Blood type and protective against coronavirus (1:13:00);
  • Distribution: the challenge of prioritizing the limited doses of vaccines after approval (1:13:15);
  • Paul’s perspective on COVID-19 vaccine safety (1:16:15);
  • Considerations regarding vaccinating children for coronavirus and the role of a fever immune response (1:21:45);
  • Why vaccine development can be challenging and risks of current COVID-19 strategies (1:29:45); and
  • More.

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Nov 16, 2020
#136 - AMA #17: Body composition methods tour de force, insulin resistance, and Topo Chico
18:01
In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss different methods to evaluate body composition. They explore ways of measuring body fat, delineating between subcutaneous and visceral fat, and go over best strategies for improving body composition and optimizing health. They also discuss insulin resistance using a patient case study that highlights interventions capable of reversing the condition. Finally, Peter addresses his level of concern about a recent Consumer Report finding that Topo Chico had the highest levels of a class of synthetic chemicals (PFAS) of all the carbonated bottled waters tested. Peter concludes by sharing if the finding will change his consumption habits. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #17 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
 
We discuss:
  • Body mass index (BMI) vs. body fat percentage (BF%) (1:45);
  • Methods of assessing body fat—Magnetic Resonance Imaging (MRI) (6:25);
  • The different types of body fat (9:00);
  • Methods of assessing body fat—Computed Tomography (CT Scan) (12:00);
  • Methods of assessing body fat—Dual-Energy X-ray Absorptiometry (DEXA) (14:30);
  • Methods of assessing body fat—Hydrostatic/Underwater Weighing (19:25);
  • Methods of assessing body fat—Air Displacement (Bod Pod) (22:25);
  • Methods of assessing body fat—Skinfold measurement (23:55);
  • Methods of assessing body fat—Total Body Water (27:15);
  • Methods of assessing body fat—Bioelectrical Impedance (BIA) (28:45);
  • The optimal body fat percentage, muscle mass, and the best strategy to improve body composition (31:30);
  • Defining insulin resistance and the steps to reverse it (40:15);
  • Patient case study: Reversing insulin resistance (49:00);
  • Addressing the recent finding of high levels of PFOA in Topo Chico (58:25); and
  • More.

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Nov 09, 2020
#135 - BJ Miller, M.D.: How understanding death leads to a better life
01:54:43
BJ Miller is a hospice and palliative care specialist on a quest to reframe our relationship with death. In this episode, BJ begins with how his own brush with death radically shifted his perspective and ultimately forged his path towards palliative care and helping patients integrate and understand their life in a meaningful way. BJ recounts several moving stories from his patients, which reveal important lessons about overcoming the fear of death, letting go of regret, and what’s most important in life. He discusses the major design flaws of a “death phobic” healthcare system. Furthermore, he makes the case that seeing death as a part of life allows us to live well, as opposed to living to evade death itself. He concludes with a discussion around physician-assisted death as well as his hopes around the use of psychedelics to reduce suffering in end-of-life care.
 
We discuss:
  • BJ’s accident leading to the loss of his limbs and his experience inside a burn unit [3:00];
  • Coping with his amputations—being tough, the grieving process, and the healing properties of tears [14:30];
  • Going from art history to medical school: the value of a diverse background in medicine [28:15];
  • How BJ’s new body liberated him [40:00];
  • How losing his sister to suicide and his disillusionment with medicine altered his path [47:15];
  • Discovering his path of palliative care—distinct from hospice—in medicine [55:30];
  • Our complicated relationship with death, and how acknowledging it can release its grip and improve living [1:02:15];
  • The different distinctions around the fear of death, and how BJ helps his patients negotiate fears [1:10:00];
  • The major design flaws of a “death phobic” healthcare system [1:14:15];
  • Common regrets, the value of time, and other insights from interactions with patients in their final moments of life [1:23:00];
  • The story of Randy Sloan—a case study of playing life out [1:33:45];
  • Physician-assisted dying: Legality and considerations [1:39:45];
  • The use of psychedelics in end-of-life care, and what BJ is most excited about going forward [1:45:45]; and
  • More.

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Nov 02, 2020
#134 - James O’Keefe, M.D.: Preventing cardiovascular disease and the risk of too much exercise.
02:09:17

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

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

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Oct 26, 2020
#133 - Vinay Prasad, M.D., M.P.H: Hallmarks of successful cancer policy
02:12:04

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

 

We discuss:

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

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Oct 19, 2020
#132 - AMA #16: Exploring hot and cold therapy
19:21

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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Oct 12, 2020
#131 - Beth Lewis: The Art of Stability: Learning about pain, mitigating injury, and moving better through life
01:51:06

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.
 
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Oct 05, 2020
#130 - Carol Tavris, Ph.D. & Elliot Aronson, Ph.D.: Recognizing and overcoming cognitive dissonance
01:59:44

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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Sep 28, 2020
#129 - Tom Dayspring, M.D.: The latest insights into cardiovascular disease and lipidology
02:00:04

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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Sep 21, 2020
#128 – Irene Davis, Ph.D.: The evolution of the foot, running injuries, and minimalist shoes
01:53:06

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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Sep 14, 2020
#127 - AMA #3 with sleep expert, Matthew Walker, Ph.D.: Fasting, gut health, blue light, caffeine, REM sleep, and more
15:34

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

We discuss:

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

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Sep 07, 2020
#126 – Matthew Walker, Ph.D.: Sleep and immune function, chronotypes, hygiene tips, and addressing questions about his book
01:41:53

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

We discuss:

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

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Aug 31, 2020
#125 - John Arnold: The most prolific philanthropist you may not have heard of
02:28:26

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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Aug 24, 2020
#124 - AMA #15: Real-world case studies—metabolic dysregulation, low testosterone, menopause, and more
16:49
As a follow up to AMA #14 where Peter explained his framework for analyzing labs, this “Ask Me Anything” (AMA) episode focuses on a number of real-world case studies exploring metabolic dysregulation, low testosterone, menopause, hypothyroidism, elevated uric acid, and more. From the examples discussed, you can follow along how our clinical team goes about interpreting diagnostic measures and applying relevant research findings. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #15 show notes page.

We discuss:

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

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Aug 17, 2020
#123 - Joan Mannick, M.D. & Nir Barzilai, M.D.: Rapamycin and metformin—longevity, immune enhancement, and COVID-19
02:17:59

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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Aug 10, 2020
#122 - Lori Gottlieb: Understanding pain, therapeutic breakthroughs, and keys to enduring emotional health
01:30:12

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

We discuss:

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

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Aug 03, 2020
#121 - Azra Raza, M.D.: Why we're losing the war on cancer
01:54:55
Azra Raza is a physician, scientist, author, and outspoken advocate for reconfiguring the current model of research in cancer. In this episode, Azra discusses the content of her book, The First Cell, which takes a critical look at the outdated models being used to study cancer resulting in a lack of progress in survival rates for cancer patients. Azra offers a solution which focuses on early detection and prevention, and she concludes with an optimistic outlook for the future of cancer research.
 
We discuss:
  • Azra’s upbringing, interest in oncology, and the basis for writing her book [3:30];
  • The lack of progress in cancer treatment over the decades [18:45];
  • What is holding the oncology field back? [33:15];
  • Do the purported advances in oncology reflect the billions of dollars spent on cancer research? [40:00];
  • Economics of new cancer drugs—how small increases in survival come with staggering financial burdens [47:00];
  • How good intentions can still lead to misaligned incentives and a broken system [1:03:00];
  • Why 95% of new cancer drugs fail—a critical review of the cancer research model [1:11:15];
  • Early detection and prevention—a potential solution to the cancer problem [1:22:30];
  • Coping with the loss of her husband to cancer [1:46:00];
  • Azra’s optimistic view of the future [1:49:30]; and
  • More.

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Jul 27, 2020
#120 - AMA with Dom D’Agostino, Ph.D., Part II of II: Ketosis for cancer and chronic disease, hyperbaric oxygen therapy, and the effect of ketosis on female health
28:27

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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Jul 20, 2020
#119 - Terry Real: Breaking the cycle of shame, anger, and depression
01:39:46

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

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

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Jul 13, 2020
#118 - Lloyd Klickstein, M.D., Ph.D.: Rapamycin, mTOR inhibition, and the biology of aging
02:14:55
Lloyd Klickstein is the Chief Science Officer at resTORbio, a biopharmaceutical company that develops medications to target the biology of aging. In this episode, Lloyd discusses his company’s clinical application of rapamycin and its derivatives. He also elucidates details of his 2014 paper—a paper that greatly influenced Peter’s perspective of rapamycin in the context of longevity. Peter and Lloyd go on to discuss the dose-dependent effect of rapamycin on immune function and compare rapamycin, fasting, and caloric restriction.
 
We discuss:
  • His background and decision to leave academia for translational medicine [6:15];
  • Translational medicine—bridging the gap between basic science and clinical medicine [10:30];
  • What prompted Lloyd to focus on mTOR inhibition? [18:00];
  • Defining mTOR, TORC1, and TORC2, and the consequences of inhibiting them with rapamycin [21:30];
  • Dose-dependent impact of rapamycin on immune function, mTOR inhibition, and toxicity [42:15];
  • Lloyd’s 2014 experiment—mTOR inhibition improves immune function in the elderly [53:00];
  • Insights into autophagy, antigen presentation, and the pleiotropic benefits of a rapalog, and how it compares to fasting [1:13:00];
  • Lloyd’s 2018 experiment—TORC1 inhibition enhances immune function and reduces infections in the elderly [1:18:45];
  • Creation of resTORbio, subsequent studies, and takeaways about dosing, TORC2 inhibition, and tissue selectivity [1:29:00];
  • Comparing the longevity effect of rapamycin, fasting, and caloric restriction [1:40:00];
  • Excitement around RTB101—resTORbio’s mTOR inhibiting molecule [1:47:00];
  • Identifying rapalogs selective for TORC1 [1:56:15];
  • Treating depression with ketamine, an activator of mTOR [2:00:00];
  • Epigenetic clocks, rapalogs, and metformin [2:03:30]; and
  • More.

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Jul 06, 2020
#117 - Stanley Perlman, M.D., Ph.D.: Insights from a coronavirus expert on COVID-19
01:43:56
In this episode, Stanley Perlman shares insights from his impressive career studying coronaviruses—both the common and more deadly ones, like MERS and SARS. In comparing preceding coronaviruses with SARS-CoV-2, Stanley discusses how other coronaviruses can aid our current understanding of, and be used to infer about, COVID-19. He also gives his thoughts on durable immunity, therapeutic strategies, and future outbreak preparedness.
 
We discuss:
  • His background and early work with coronaviruses [2:45];
  • The coronavirus family—various types, common traits, and scientific understanding [9:00];
  • The origin of viruses, animal to human transmission, R_0, immunity, and more [17:45];
  • Insights from the 2002 SARS outbreak [28:30];
  • Insights from the 2012 MERS outbreak [35:00];
  • Comparing SARS-CoV-2 to MERS, SARS, and other coronaviruses [42:00];
  • COVID-19 survivor potential for long-term damage [53:30];
  • Using the current pandemic for lessons on future preparedness [57:00];
  • Genetic drift and the potential for long-term immunity to COVID-19 [1:07:00];
  • Prevention and treatment strategies for COVID-19 and future diseases [1:22:30];
  • Alternative hypothesis to the origin of SARS-CoV-2 [1:32:30];
  • Determining durable immunity to COVID-19 and what a successful vaccine looks like  [1:34:30]; and
  • More.

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Jun 29, 2020
#116 - AMA with Dom D’Agostino, Ph.D., Part I of II: Ketogenic diet, exogenous ketones, and exercise
28:27

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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Jun 22, 2020
#115 - David Watkins, Ph.D.: A masterclass in immunology, monoclonal antibodies, and vaccine strategies for COVID-19
01:37:32

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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Jun 15, 2020
#114 - Eileen White, Ph.D.: Autophagy, fasting, and promising new cancer therapies
01:58:55

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

We discuss:

 

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

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Jun 08, 2020
#113: Normative errors—a conversation with my daughter about current events
22:07

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

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Jun 03, 2020
#112 - Ned David, Ph.D.: How cellular senescence influences aging, and what we can do about it
02:15:34

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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Jun 01, 2020
#111 - AMA #14: What lab tests can (and cannot) inform us about our overall objective of longevity
17:11

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

We discuss:

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

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May 18, 2020
#110 - Lew Cantley, Ph.D.: Cancer metabolism, cancer therapies, and the discovery of PI3K
02:11:22

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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May 11, 2020
#109 - John Dudley: The beauty in archery, the love of practice, and a model system for life
02:16:34
In this episode, professional archer, John Dudley, shares the many insights he’s gleaned through the process of not only becoming an elite competitor of archery but also an exceptional teacher. John describes how his desire for improvement has cultivated a sheer love of practice, and how pursuing mastery helped put into context how archery is an amazing model system for life. Additionally, John discusses the often misunderstood nature of hunting, but also makes the case as to why one should consider trying archery even if there is no desire to hunt.
 
We discuss:
  • Why John loves archery, and what it means to be a professional archer [4:50];
  • How John’s love of practice and training led to archery [10:45];
  • How an intense desire to improve drove John to quit football and pursue archery [22:00];
  • A traumatic childhood event that changed John’s course from troublemaker to committed athlete [34:15];
  • The nuts and bolts of archery—Competitive events, types of bows, hunting, etc. [45:30];
  • The blissful nature of archery, and the uselessness of anger [57:15];
  • Hyper-focus and flow states—Did John’s ADD and task-driven personality give him an advantage? [1:07:15];
  • The common traits found in the most successful people [1:12:45];
  • The keys to maintaining credibility as a salesman—Integrity, honesty, and straightforwardness [1:18:45];
  • The coaching technique that makes John a great teacher [1:28:30];
  • Why you should consider trying archery (even if you never want to hunt) [1:36:15];
  • Hunting discussion—The morality argument, hunting vs. commercial farming, managing overpopulation, and the unique emotional connection [1:45:00];
  • Resources for those interested in taking up archery [2:12:00]; and
  • More.

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May 04, 2020
#108 - AMA #13: 3-day fasting, exogenous ketones, autophagy, and exercise for longevity
15:30

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


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

We discuss:

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

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Apr 21, 2020
#107 - John Barry: 1918 Spanish flu pandemic—historical account, parallels to today, and lessons
01:21:55

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

We discuss:

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

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Apr 17, 2020
#106 - Amesh Adalja, M.D.: Comparing COVID-19 to past pandemics, preparing for the future, and reasons for optimism
44:24

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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Apr 13, 2020
#105 - Paul Conti, M.D.: The psychological toll of a pandemic, and the societal problems it has highlighted
01:26:44

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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Apr 10, 2020
#104 - COVID-19 for kids with Olivia Attia
34:16

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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Apr 08, 2020
#103 - Looking back on the first 99 episodes: Strong Convictions, Loosely Held
01:17:23

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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Apr 06, 2020
#102 - Michael Osterholm, Ph.D.: COVID-19—Lessons learned, challenges ahead, and reasons for optimism and concern
01:22:23

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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Mar 31, 2020
#101 - Ryan Holiday: Finding stillness amidst chaos
01:22:44


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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Mar 27, 2020
#100 - Sam Harris, Ph.D.: COVID-19—Comprehending the crisis and managing our emotions
01:32:25

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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Mar 24, 2020
#99 - Peter Hotez, M.D., Ph.D.: Continuing the conversation on COVID-19
01:06:21

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.

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Mar 20, 2020
Qualy #129 - Evolutionary reasons to sleep
09:42

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 cardone 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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Mar 17, 2020
#97 - Peter Hotez, M.D., Ph.D.: COVID-19: transmissibility, vaccines, risk reduction, and treatment
57:01

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.

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Mar 14, 2020
Qualy #125 - Hierarchies in healthcare, physician burnout, and a broken system
13:25

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 cardone 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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Mar 10, 2020
#96 - David Epstein: How a range of experience leads to better performance in a highly specialized world
02:37:10

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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Mar 09, 2020
Qualy #121 - The “art” of longevity: the challenge of preventative medicine and understanding risk
10:27

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 cardone 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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Mar 03, 2020
#95 - Luke Bennett, M.D.: The emotional, cognitive, and physical demands that make Formula 1 a unique and special sport
01:38:31

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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Mar 02, 2020
Qualy #120 - What is the difference between ketone salts and esters?
06:29

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 cardone 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 

Feb 28, 2020
#94 - Mark Hyman, M.D.: The impact of the food system on our health and the environment
01:50:28

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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Feb 24, 2020
Qualy #116 - Dealing with anger in spots where you know it’s coming
08:48

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 cardone 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 

Feb 21, 2020
#93 - AMA with Jason Fried: Work-life balance, avoiding burnout, defining success, company culture, and more
02:07:39

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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Feb 17, 2020
Qualy #109 - How does one select the right physician as a patient?
09:40

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 cardone 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 

Feb 11, 2020
92 - AMA #12: Strategies for longevity (which don't require a doctor)
15:03

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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Feb 10, 2020
Qualy #106 - Does LDL cause heart disease?
09:41

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 cardone 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

Feb 05, 2020
#91 – Eric Topol, M.D.: Can AI empower physicians and revolutionize patient care?
02:01:03

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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Feb 03, 2020
Qualy #102 - Is the food industry still saying that all calories contribute equally to adiposity and insulin resistance?
07:58

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 cardone 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 

Jan 29, 2020
#90 - Ryan Holiday: Stillness, stoicism, and suffering less
02:16:06

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

We discuss:

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

Learn more: https://peterattiamd.com/

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

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Jan 27, 2020
Qualy #99 - The steroid controversy: Mark’s use of them and Peter’s perspective
11:01

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 cardone 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 

Jan 23, 2020
#89 - AMA #11: All things fasting
14:32

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/

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Jan 20, 2020
Qualy #94 - Comparing the two broad types of meditation, and Peter’s favorite meditation apps
07:14

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 cardone 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 

Jan 15, 2020
Qualy #89 - Cortisol and healthy aging
09:37

Today's episode of The Qualys is from podcast #31 – Navdeep Chandel, Ph.D.: metabolism, mitochondria, and metformin in health and disease.

 

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race cardone 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

Jan 07, 2020
#87 - Rick Johnson, M.D.: Fructose—The common link in high blood pressure, insulin resistance, T2D, & obesity?
01:50:47

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

We discuss: 

  • The connection between blood pressure and fructose that shifted Rick’s professional focus [4:00];
  • The relationship between salt and blood pressure (and the role of sugar) [5:45];
  • Defining fructose, glucose, and sugar [19:30];
  • An ancient mutation in apes that explains why humans turn fructose into fat so easily [23:00];
  • The problems with elevated uric acid levels, and what it tells us about how sugar causes disease [31:30];
  • How sugar causes obesity—explaining the difference in glucose vs. fructose metabolism and the critical pathway induced by fructose [40:00];
  • Why drinking sugar is worse than eating it [50:00];
  • Unique ability of sugar to drive oxidative stress to the mitochondria, insulin resistance, and diabetes [54:00];
  • Why cancer loves fructose [1:00:15];
  • The many areas of the body that can use fructose [1:05:00];
  • Fructokinase inhibitors—a potential blockbuster? [1:07:15];
  • Treating high uric acid levels—Rick’s approach with patients [1:10:00];
  • Salt intake—what advice does Rick give his patients? [1:16:30];
  • How excess glucose (i.e., high carb diets) can cause problems even in the absence of fructose [1:21:00];
  • Artificial sweeteners vs. real sugar—which is better? [1:29:15];
  • Umami, MSG, alcohol, beer—do these have a role in metabolic illness? [1:33:45];
  • Fructose consumption—Is any amount acceptable? Is fruit okay? Where does Rick draw a hard line? [1:38:45]
  • How does Rick manage the sugar intake of his young kids? [1:43:00]; and
  • More.

Learn more: https://peterattiamd.com/

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

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Jan 06, 2020
Qualy #85 - The past, present, and future of medicine, hospitals, and healthcare
13:03

Today's episode of The Qualys is from podcast #06 – D.A. Wallach: music, medicine, longevity, and disruptive technologies.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race cardone 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 

Dec 31, 2019
#86 - Damon Hill: Overcoming loss, achieving success, and finding one's identity
02:27:00

In this episode, Damon Hill, 1996 Formula 1 World Champion, opens up about his personal struggles with depression, feelings of inadequacy, loss of identity, and his ultimate path to healing following his remarkable racing career. Damon’s life was given a tragic jolt at 15 years of age when his father and legendary F1 driver Graham Hill died suddenly—the common string that ties together so much of his life and has forged so much of who he is to this day. We discuss Damon’s unique and remarkable racing career including his legendary battles with Michael Schumacher as well as Damon's firsthand account of what happened that tragic day on May 1st, 1994, when his teammate, Ayrton Senna, died at Imola. But this is not just about racing; rather it’s a human story that's cloaked in a racing one.

Learn more: https://peterattiamd.com/

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

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Dec 30, 2019
Qualy #82 - What is the most common first presentation of heart disease?
07:06

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 cardone 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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Dec 25, 2019
#85 - Iñigo San Millán, Ph.D.: Mitochondria, exercise, and metabolic health
02:53:03

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

We discuss:

  • Iñigo’s background in sports and decision to focus on education [7:15];

  • Explaining the various energy systems and fuels used during exercise [14:45];

  • Iñigo qualifies energy systems into six training zones [26:00]; 

  • Lactate is an important fuel source [33:00];

  • Zone 2 training—physiologic characteristics, fuel sources, lactate, and the transition into zone 3 [40:30];

  • Using blood lactate levels (and zone-2 threshold) to assess mitochondrial function [47:00];

  • Accessing mitochondrial function by looking at one’s ability to utilize fat as fuel (with an RQ test) [55:00];

  • Athletes vs. metabolically ill patients—mitochondria, fat oxidation, muscle glycogen capacity, “fat droplets”, and more [1:00:00];

  • Physiologic characteristics of zone 3, zone 4, and the lactate threshold [1:20:00];

  • Fueling exercise—dietary implications on glycolytic function [1:30:30];

  • Relationship between exercise and insulin sensitivity (and what we can learn from studying patients with type 1 diabetes) [1:46:30];

  • Metformin’s impact on mitochondrial function, lactate production, and how this affects the benefits of exercise [2:04:15];

  • Raising awareness for risk of “double diabetes” [2:15:00];

  • How to dose zone 2 training, and balancing exercise with nutrition [2:18:00];

  • Proposed explanation of the Warburg Effect: Role of lactate in carcinogenesis [2:27:00];

  • Doping in cycling, and the trend towards altitude training [2:39:15] and;

  • More.

Learn more: https://peterattiamd.com/

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

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Dec 23, 2019
Qualy #80 - The four pillars of charity: water that helped it overcome the stigma of nonprofits and become successful
11:45

Today's episode of The Qualys is from podcast #25 – Scott Harrison: transformation, finding meaning, and taking on the global water crisis.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race cardone 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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Dec 20, 2019
#84 - AMA #10: Low testosterone, hypothyroidism, building muscle (and preserving it while fasting)
10:33

In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter’s head of research, asks the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA.

If you’re a subscriber, you can now listen to this full episode on your private RSS feed. You can also listen to this full episode on our website at the AMA #10 show notes page.

We discuss:

  • Does testosterone supplementation impact longevity? [2:40];
  • Under what conditions does Peter decide to treat patients who have low testosterone? [8:50];
  • Are there risks involved with testosterone replacement therapy? [17:10];
  • How does Peter diagnose and treat hypothyroidism? [21:30];
  • How might someone do time-restricted feeding while also adding muscle mass? [26:30];
  • If building muscle requires higher levels of IGF-1, should we be concerned about longevity? [34:45];
  • How to preserve muscle mass while fasting [41:45];
  • Is it possible to simultaneously lose fat and add muscle mass? [46:30]; and
  • More.

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/ama10

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Dec 16, 2019
Qualy #73 - How can we change the food system when 10 companies control almost 90 percent of the calories we consume in the US?
08:57

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 cardone 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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Dec 10, 2019
#83 - Bill Harris, Ph.D.: Omega-3 fatty acids
02:02:26

In this episode, Bill Harris, Ph.D. in human nutrition and expert on omega-3 fatty acids, sets the table by clearly defining the families of fatty acids (saturated, monounsaturated, polyunsaturated) before diving into the current landscape of polyunsaturated fat (omega-6 and omega-3) with a particular focus on EPA and DHA (the two main elements of fish oil supplements). Bill gives a historical overview, updates us on the latest science related to the health benefits, and provides plenty of insights as to how we should think about increasing our EPA and DHA intake.

We discuss:

  • Bill’s long history of studying fatty acids [6:30];
  • Defining the fatty acids—SFA, MUFA, PUFA, omega-3, omega-6, and more [9:45];
  • What is the significance of fatty acids? Why should we care? [19:45];
  • History of fat phobia, saturated fat, and does PUFA reduce cholesterol? [23:45];
  • Breaking down the conversion process of omega-6 and omega-3 fatty acids including how we get to EPA and DHA [28:00];
  • Takeaway from Bill’s 1980 study looking at how salmon oil affected cholesterol and triglyceride levels [36:15];
  • History of our understanding of omega-3 and its effect on LDL cholesterol [45:00];
  • Prescribed fish oil drugs vs. OTC supplements—Differences and recommended brands [52:00];
  • Health benefits of EPA [57:45];
  • Potential benefits of ALA and how it compares to taking EPA and DHA directly [1:12:45];
  • Health benefits of DHA [1:17:15];
  • Cell membrane omega-3 index—What is it, the role of genetics, how to increase it, and a recommended target [1:19:00];
  • Is EPA or DHA neuroprotective? Can it help with depression? [1:23:30];
  • Recommended fish to eat for EPA and DHA - Any mercury concerns? [1:25:45];
  • Can omega-3 mitigate risks associated with smoking? [1:29:15];
  • The problem with the omega-6 to omega-3 ratio [1:30:00];
  • The problem with labeling any kind of fatty acid as “bad” [1:36:00];
  • Why increasing EPA and DHA intake matters more than reducing omega-6 intake [1:38:00];
  • Important takeaway from the VITAL study [1:46:30];
  • Importance of testing your omega-3 index [1:53:00];
  • Exciting study coming out soon, and why you need to take your fish oil with food [1:57:15]; and
  • More.

Learn more: https://peterattiamd.com/

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

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Dec 09, 2019
Qualy #69 - Advice to parents and kids for creating a sustainable environment that’s going to prevent them from running into metabolic problems
09:05

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 cardone 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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Dec 03, 2019
#82 - Mark Messier: Leadership, personal growth, and performing under pressure
02:10:00

In this episode, Mark Messier, six-time Stanley Cup champion, shares the most valuable lessons he picked up over 25+ years of professional hockey resulting in one of the longest and most decorated careers in hockey history. Mark shares what lead to his unique brand of humble leadership, how he was able to get talented individuals to effectively work as a team, the importance of maturing and evolving as a person, and how he was able to stay calm and perform at his best under enormous amounts of pressure. Additionally, we go through his favorite moments as a player, what it was like playing with and learning from The Great One, Wayne Gretzky, and much more.

We discuss:

  • Overview of Mark’s extraordinary 25+ year professional hockey career [7:15];
  • The trend towards kids focusing on one sport earlier and earlier—A good or bad thing? [12:00];
  • Mark’s early passion for hockey, and when he realized it could be his “job” [14:15];
  • Going pro at age 17 [19:30];
  • Mark’s favorite experience playing professional hockey [25:45];
  • Playing with (and learning from) the great Wayne Gretzky [26:40];
  • A hard lesson learned in his first year as a pro [32:00];
  • Lessons learned from losing his first Stanley Cup Finals [35:45];
  • Redemption—Winning his first Stanley Cup and the beginning of a dynasty in Edmonton [41:15];
  • Importance of team character [54:00];
  • The shocking trade of Wayne Gretzky, and Mark stepping up as the new leader and team captain [59:30];
  • Playing for the New York Rangers—the lure of the city and the pressure to perform [1:07:00];
  • Ending the 54-year championship drought for the New York Rangers [1:13:30];
  • Becoming a great leader [1:16:30];
  • How to win the mental war against your opponent [1:20:30];
  • Opposing players for which Mark had great respect [1:22:00];
  • Retiring after an unbelievably long and lustrous career [1:27:00];
  • How to leverage stress and nervousness into a positive force [1:32:45];
  • The most important quality—A willingness to learn, improve, and evolve [1:36:00];
  • What does Mark do today for exercise to stay in great shape? [1:44:30];
  • Why playing sports is such a great thing for kids [1:49:30];
  • The Mark Messier Foundation [1:53:00];
  • How has Mark avoided the “loss of identity” feeling which plagues many retired athletes? [1:56:15];
  • Does Mark think it’s possible to reproduce a team as good as his Oilers teams of the 80s? [1:59:30];
  • Would Mark ever want to coach in the NHL? [2:03:00];
  • Will the Toronto Maple Leafs ever win the Stanley cup? [2:04:00]; and
  • More.

Learn more: https://peterattiamd.com/

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

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Dec 02, 2019
Qualy #65 - The three laws of medicine — Law #1: A strong intuition is much more powerful than a weak test
06:13

Today's episode of The Qualys is from podcast #32 – Siddhartha Mukherjee, M.D., Ph.D.: new frontiers in cancer therapy, medicine, and the writing process

 

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race cardone 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 

Nov 26, 2019
#81 - Debra Kimless, M.D. & Steve Goldner, J.D.: Cannabis – the latest science on CBD & THC
02:11:35

In this episode, Dr. Debra Kimless and Steve Goldner share their knowledge on the science, policy, and market evolution of medicinal cannabis. We start with the differences between THC and CBD, how they work in the body, and how they act on the brain. We discuss the many potential benefits of using CBD, THC, hemp in the various forms of administration (smoking, vaping, edibles, oils, etc.) as well as some of the safety issues including the recent uptick in incidents of hospitalization and death linked to vaping. Debra and Steve are both involved with the company, Pure Green—Debra the Chief Medical Officer and Steve the founder and CEO—whose aim is to create the safest, most efficacious form of delivery of cannabis. Their bigger mission is to shift the perception of the cannabis plant, garner acceptance of its medicinal benefits, and ultimately get it descheduled on a federal level so more people can access cannabis for a range of chronic ailments.

We discuss:

  • Debra and Steve’s background reason for their interest in medical cannabis [7:00];
  • The history of medical use of cannabis [11:15];
  • How THC, CBD, and other cannabinoids work [16:00];
  • Hemp—What it is, special uses, and the 2018 farm bill [22:45];
  • The legal status of CBD, Deb and Steve’s clinical trial, and how CBD differs from THC [30:15];
  • The safety profile of THC [35:00];
  • Is marijuana as a gateway drug? [45:30];
  • Smoking vs. vaping vs. edibles—Benefits, risks, and mechanistic differences [53:30];
  • Can you build up a tolerance to the effects of THC? [1:15:00];
  • What do people generally want to get from using marijuana? [1:17:15];
  • Cannabinoid synthetics [1:22:30];
  • Efficacy of CBD oils as a sleep aid [1:25:00];
  • Pure Green Cannabis [1:30:30];
  • Anecdotal evidence and managing the hype surrounding cannabis in medical treatment [1:38:45];
  • Aspirations for the future of medicinal cannabis, and the legal challenges that await them [1:45:15];
  • Descheduling cannabis: A human rights issue [2:04:00] and;
  • More.

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/debrakimless-stevegoldner/

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Nov 25, 2019
Qualy #61 - Rapamycin in cancer treatment
10:14

Today's episode of The Qualys is from podcast #10 – Matt Kaeberlein, Ph.D.: rapamycin and dogs — man’s best friends? — living longer, healthier lives and turning back the clock on aging and age-related diseases.

 

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race cardone 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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Nov 19, 2019
#80 - Celebrity AMA #1: Fasting, rapamycin, performance vs. longevity, and more
12:06

In this special, bonus celebrity AMA episode, Peter answers questions from former Olympians and past guests, Apolo Ohno and Sasha Cohen, on a wide range of subjects including fasting, learning, training for performance versus longevity, and much more. This bonus AMA is available in full to everyone.

  • Apolo's questions begin [1:45];
  • Why women may have a harder time fasting, and tips for those who are struggling [2:10];
  • Is there any place for fasting as part of a nutritional strategy in adolescents? [6:15];
  • Tips for learning and retaining large amounts of new information (and the best nutritional approach) [9:15];
  • Must read books of 2019 [14:45;
  • If you could only keep a few watches for the rest of your life which would they be? [16:45];
  • What workout would Peter do inside a hotel room? [22:15];
  • What is Peter’s ultimate gorge meal? [23:45];
  • How do you foresee fasting as a mechanism for performance in athletes? [25:30];
  • What is driving Peter to strive for excellence? [33:30];
  • Sasha's questions begin [38:40];
  • What are you most excited about in the longevity space? [38:45];
  • At what point do you see enough data or proof that a new drug, or type of fasting is worth trying it out for yourself? [41:30];
  • Is it possible to obsess so much about your health that it becomes a negative stressor? [46:45];
  • Which tests are worth doing if you want to be proactive about your health? [48:15];
  • Are there any supplements Peter things are beneficial to be taking? [55:15];
  • How does Peter’s training differ when optimizing for performance versus longevity? [56:30];
  • How does taking testosterone and growth hormone affect performance versus longevity? [59:15]; and
  • More.

Learn more: https://peterattiamd.com/

Show notes page for this episode:https://peterattiamd.com/celebrityama01

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Nov 18, 2019
Qualy #57 - A primer on NAD+/NADH, its effect on lifespan/healthspan, and a review of the supplements
08:28

Today's episode of The Qualys is from podcast #02 – Rhonda Patrick, Ph.D.: the performance and longevity paradox of IGF-1, ketogenic diets and genetics, the health benefits of sauna, NAD+, and more.

 

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race cardone 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

Nov 12, 2019
#79 - Ric Elias: Earning the gift of life
01:41:53

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

We discuss:

  • Ric’s life leading up to the day of the plane crash [5:30];
  • The plane crash—What it’s like knowing you’re about to die, feelings of regret and sadness [11:15];
  • The improbable plane landing in the Hudson River [19:00];
  • Emotions after the safe landing (and a story he’s never told before) [25:45];
  • A powerful story about Captain Sully [29:30];
  • Earning his second chance at life, and playing the “infinite game” [38:30];
  • Why time is the ultimate currency, and how (and why) to say “no” [46:15];
  • Raising kids in an achievement culture, Ric’s definition of life success, and what Ric wants to instill in his kids [53:00];
  • What Ric believes is actually worth getting upset, and the organizations that are taking steps to help people [1:09:00];
  • The core principles of Red Ventures (Ric’s company) [1:19:15];
  • Ric’s tips for developing business acumen and negotiation skills [1:29:30];
  • What qualities does Ric look for in people he wants to work with? [1:32:50];
  • What is the next big problem that Ric wants to solve? [1:35:30];
  • What is the most challenging part of your business today? [1:37:30];
  • If Ric could go back and talk to himself in the morning before getting on that plane, what would he say? [1:39:15]; and
  • More.

Learn more: https://peterattiamd.com/

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

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Nov 11, 2019
Qualy #53 - Screening for prostate cancer
16:38

Today's episode of The Qualys is from podcast #39 – Ted Schaeffer, M.D., Ph.D.: How to catch, treat, and survive prostate cancer.  

 

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race cardone 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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Nov 05, 2019
#78 - Sasha Cohen: The price of achievement, and redefining success
02:13:48

In this episode, Sasha Cohen, former US Olympic figure skater, discusses the most challenging things about life as an Olympian—the pressures, the expectations, years of sacrifice, but worst of all a loss of identity post-career resulting in many former Olympians suffering from depression. We begin by talking about everything that led up to her unforgettable moment from the 2006 Olympics, and how she handled herself so beautifully in the face of disaster. Most importantly, we talk about post-skating life when she shares many insights such as the downside of constantly striving for a moment, the hollowness of achievement, and the importance of redefining our definition of success.

We discuss:

  • Sasha’s mindset going into the 2006 Olympics as the favorite [6:30];
  • Figure skating basics, scoring, short program vs. long program, etc. [13:40];
  • Sasha’s unforgettable performance at the 2006 Olympics [18:10];
  • Win, lose, or draw, why many Olympians suffer from a loss of identity [32:30];
  • Dealing with the disappointment of “losing the gold” [40:30];
  • The tiny window of opportunity for Olympians, and the overwhelming pressure to meet expectations [49:30];
  • Sasha’s unique childhood, finding figure skating, and channeling her hyperactive personality into becoming an amazing skater [1:01:30];
  • The consequences of extreme training at a young age, and trying to control the uncontrollable [1:10:00];
  • What is driving extreme athletes and Olympians to be the best? [1:18:30];
  • Why many former Olympians and athletes struggle with depression [1:25:00];
  • Refining success—How Sasha overcame her own loss of identity [1:32:30];
  • What advice would Sasha give her 15-year-old self? [1:40:45];
  • Lessons we can learn from watching the rapid downfall of many former Olympians [1:45:00];
  • Advice for people who are tying their identity to being “successful” or striving to be “the best” [1:56:00];
  • Life lessons Sasha wants to apply to being a mother to her baby boy she is expecting [2:05:00]; and
  • More.

Learn more: https://peterattiamd.com/

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

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Nov 04, 2019
Qualy #52 - Insights about berberine
05:13

Today's episode of The Qualys is from podcast #26 – AMA #3: supplements, women’s health, patient care, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race cardone 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 

Nov 01, 2019
#77 – AMA #2 with sleep expert, Matthew Walker, Ph.D.: short sleep mutants, optimal sleep environment, sleep apnea, & rapid fire questions
29:05

In this special episode, Matthew Walker returns for his second AMA episode where he provides his expert insight on numerous sleep-related questions directly from listeners. He answers a wide range of questions from the gene that causes the short sleeping phenotype, to the ideal sleeping position, to the optimal temperature for best sleep, to how fasting affects sleep, plus a full dissertation on sleep apnea, and much, much more.

We discuss:

  • DEC2—A genetic mutation that produces a short sleeping phenotype [11:00];
  • What is the best position to sleep in? [22:45];
  • Should you consider a “sleep divorce” with your partner? [27:00];
  • The challenge of kids wanting to sleep in bed with their parents [28:45];
  • Is there an ideal type of pillow? [32:30];
  • Any data on hammock sleeping? Should adults be rocked to sleep like a baby? [34:45];
  • The optimal room temperature and body temperature for the best sleep [38:30];
  • Do humidifiers help? [50:40];
  • How do high altitudes affect sleep? [53:15];
  • What is the data on weighted blankets (e.g., the Gravity blanket)? [57:00];
  • Caffeine—How much, and in what way, does it affect sleep? [58:15];
  • How does sexual activity relate to sleep quality? [1:04:00];
  • Should we be sleeping in two phases? First sleep & second sleep? [1:06:30];
  • Napping—Is there ideal duration? Should we be napping or not? [1:08:30];
  • Advice for new parents dealing with sleep deprivation [1:12:00];
  • Understanding your sleep chronotype [1:16:15];
  • If you drink too much alcohol in a given night, is there anything you can do to make sure your sleep isn’t wrecked? [1:20:45];
  • How postmenopausal women can manage their sleep problems with (and without) hormone replacement therapy [1:23:00];
  • Could a daily practice of Wim Hof's breathing method help or hinder quality of sleep? [1:29:15];
  • Why do some people paradoxically feel more tired the more they sleep? [1:31:15];
  • Sleep apnea—How to know if you have it, the different types, the causes, and helpful resources [1:33:15];
  • Is there such a thing called “sleep eating”? [1:45:00];
  • If Matt was “sleep czar”, what changes would he make to society to improve sleep? [1:46:15];
  • Catch up sleep: Explaining the difference between retrospective damage and prospective benefit [1:48:45];
  • Does poor sleep really speed up the aging process? [1:50:30];
  • Is medicated sleep better than no sleep? [1:53:00];
  • Does vivid dreaming disrupt the sleep cycle? [1:56:45];
  • Is there potential benefit to using “binaural beats” or some type of sound to induce better sleep? [1:57:45];
  • How is sleep affected by fasting and time-restricted eating? [1:59:45];
  • Is there any evidence that polyphasic sleep (e.g., "Uberman") works? [2:03:30]; and
  • More.

Learn more: https://peterattiamd.com/

Show notes page for this episode: peterattiamd.com/matthewwalkerama2/

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Oct 28, 2019
Qualy #46 - Rapamycin’s effects on cancer, cardiovascular disease, and neurodegeneration
08:26

Today's episode of The Qualys is from podcast #09 – David Sabatini, M.D., Ph.D.: rapamycin and the discovery of mTOR — the nexus of aging and longevity?.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race cardone 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 

Oct 23, 2019
#76 - Kyle Kingsbury: Finding meaning, depression, and psychedelics
01:41:31

In this episode, Kyle Kingsbury, retired UFC fighter and director of human optimization at Onnit, discusses the purpose and meaning that football and MMA gave him but which also acted as a distraction from his inner demons. Kyle opens up about his use of PEDs (steroids, testosterone, HGH) in college and talks about some of the misconceptions around them. Next, Kyle talks about his battle with depression and a close call with suicide that lead to life-changing experiences with psilocybin and ayahuasca—which really became the turning point in his own journey towards being more emotionally healthy, finding inner peace, and being a better husband and father. *DISCLAIMER: The substances spoken about in this episode are illegal and by no means are we advocating for anyone to use them or experiment with them. There are physical, physiological, psychological, and legal risks around the use of these plants. This conversation is purely informational only.

We discuss:

  • Growing up in a volatile home [6:30];
  • Playing college football at ASU, and letting go of NFL aspirations [15:45];
  • Kyle’s experience taking anabolics (steroids/testosterone), misunderstood science, and fear mongering [23:15];
  • Kyle’s experience with taking HGH [35:30];
  • The Whizzinator [36:45];
  • Struggles with depression and drugs, and a lack of meaning after football [41:00];
  • Kyle’s close call with suicide, and a spiritual experience [47:15];
  • Finding refuge with mixed martial arts, and Kyle’s early success in cage fighting [52:30];
  • Lessons from Kyle’s first loss in fighting, and training for the UFC [59:45];
  • First experiences with psilocybin and ayahuasca, quieting the monkey mind, and finding inner peace [1:07:15];
  • Overt vs. covert depression, depression in men vs. women, and the transition from adaptive to maladaptive behaviors [1:16:00];
  • Peeling back the layers with ayahuasca: Kyle tells stories about the most transformative experiences with psychedelics [1:19:00];
  • Does Kyle feel like he has lost his “edge” as a result of his journey? [1:26:15];
  • Where would Kyle be had he not discovered the power of psychedelic medicines? [1:29:45];
  • Parenting: Stopping the cycle of trauma, reconnecting to our ancestral roots, and Kyle’s opinion on ayahuasca as a potential tool for kids [1:31:40];
  • Relationship with parents, blind spots, compassion, and forgiveness [1:37:15]; and
  • More.

Learn more: https://peterattiamd.com/

Show notes page for this episode:peterattiamd.com/kylekingsbury/

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Oct 21, 2019
Qualy #43 - What are Peter’s thoughts on fasting and ketosis for females?
08:17

Today's episode of The Qualys is from podcast #26 – AMA #3: supplements, women’s health, patient care, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race cardone 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 

Oct 17, 2019
#75 - David Light: Zantac recall due to cancer concerns – what you need to know
01:37:30

In this episode, David Light, CEO of Valisure (the company which alerted the FDA to the Zantac cancer concerns), explains the story behind the recent recalls by manufacturers of ranitidine, a common heartburn medication, sold under the trade name Zantac, due to a potential link to increased cancer risk. David breaks down all the evidence, the role of his unique pharmacy company which tests all its drugs before being dispensed to consumers, and the reason behind the FDA’s tempered reaction to the alarming study results. David makes the argument that Zantac/ranitidine is an inherently unstable molecule which explains the grossly excessive amounts of NDMA (a probable human carcinogen) as opposed to just a contamination for which there could be numerous causes. Finally, David and Peter both provide recommendations for what to do if you or someone you know is currently taking Zantac/ranitidine.

We discuss:

  • The impetus for starting Valisure, a unique online pharmacy that tests all its medications [6:45];
  • The story behind the recall of valsartan, and the role which Valisure played [24:30];
  • Testing Zantac: The shocking results from Valisure’s initial testing with major potential cancer implications [36:00];
  • NDMA - the probable human carcinogen found in Zantac/ranitidine [48:45];
  • The epidemiology question: Are we inferring too much from epidemiology? What can we take away from the existing studies? [53:30];
  • The staggering results from the 2016 Stanford study, why it didn’t alarm more people, and how Valisure found the missing biological link [1:01:30];
  • Alerting the FDA, the FDA’s tempered response, and question of contamination vs. inherent instability [1:07:30];
  • How confident is David that the elevated levels of NDMA being found in ranitidine are not due to instrumentation, human error, or temperature contamination? [1:24:15];
  • The massive risk being taken by the FDA by not doing more to keep ranitidine away from consumers [1:25:15];
  • If someone is taking Zantac/ranitidine, what should they do? What else do they need to know? [1:27:45]; and
  • More.

Learn more: https://peterattiamd.com/

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

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Oct 14, 2019
Qualy #38 - Finding meaning in struggle and why we are less happy than ever (David Foster Wallace)
07:16

Today's episode of The Qualys is from podcast #15 – Paul Conti, M.D.: trauma, suicide, community, and self-compassion.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race cardone 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 

Oct 09, 2019
#74 – Jason Fried: Optimizing efficiency and work-life balance
02:24:35

In this episode, Jason Fried, co-founder of Basecamp, shares his beliefs around achieving business success in a modern world which tends to disproportionately focus on the massive success stories (the outliers). Jason gives his honest take on companies like WeWork, Uber, and Lyft that may give off the appearance of wild success but may instead provide an example of the dangers of perverse incentives. We get into Jason’s backstory, and how his affinity for optimizing efficiency and production in the workplace culminated with the creation of Basecamp, his very successful web-based project management software business. Perhaps most importantly, we get really deep into all aspects of work-life balance and what it really means to “work hard” (Stay tuned for an AMA-style deep dive into the topic of work-life balance with Jason in the near future). In addition, Jason provides many more valuable nuggets including thoughts on some common mistakes made by businesses today, the value of giving employees autonomy, how to take the right types of risks, why he doesn’t set any goals, and much, much more.

We discuss:

  • Jason’s background and his early entrepreneurial spirit [9:45];
  • Views on completing higher education and the notion of hard work [24:00];
  • Beliefs around success in business [35:00];
  • WeWork, Uber, and Lyft: Poor business practices and the dangers of perverse incentives [41:30];
  • Jason’s early career: his redesign approach and personal motivation [56:00];
  • The genesis of Basecamp [1:10:00];
  • Why Jason does not set goals but instead focuses on a vision [1:12:15];
  • Workplace motivation and hiring practice [1:20:30];
  • The importance of luck and not overworking [1:32:00];
  • A framework to work less and optimize for workplace autonomy [1:38:00];
  • The importance of saying ‘no’ more often (and tips for doing so) [1:55:00];
  • A shared passion for watches [2:03:30];
  • Guarding against the perils of phone addiction [2:08:45];
  • Jason’s views on email and chat for communication [2:15:00] and;
  • More.

Learn more: https://peterattiamd.com/

Show notes page for this episode:peterattiamd.com/jasonfried

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Oct 07, 2019
Qualy #33 - How silent bravado and incessant striving can lead to a functional (and actual) death, and why Paul is critical of the current state of psychiatry
09:13

Today's episode of The Qualys is from podcast #15 – Paul Conti, M.D.: trauma, suicide, community, and self-compassion.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race cardone 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

Oct 01, 2019
#73 - AMA #9: NAD & metformin, fat-burning zone, creatine, estrogenization of men, emergency kit for cold & flu, and more
16:08

In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter’s head of research, asks the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA.

If you’re a subscriber, you can now listen to this full episode on your private RSS feed. You can also watch (or listen) to this full episode on our website at the AMA #9 show notes page.

Questions continue to be pulled from the AMA section on the website, and any subscriber is welcome to submit questions for future AMAs.

We discuss:

  • The story of how Peter almost worked for Theranos [2:00];
  • The trend of lower testosterone and higher estrogen in men: Why is it happening and what to do about it? [10:00];
  • Takeaways from Peter’s recent hunting trip in Hawaii [14:45];
  • What books are you currently reading/listening to? [21:30];
  • What advice would you give to the 25 year-old Peter? [24:00];
  • What is your emergency protocol if you start getting sick? [27:45];
  • How have your thoughts changed on NAD precursors, and also on metformin, in the past year or so? [30:30];
  • What are your thoughts on “fat burning” zones for cardio workouts? — A lesson in relative vs. absolute fat combustion [34:15];
  • What mental models do you use and how do you go about solving problems and approaching difficult questions? [49:00];
  • Creatine supplementation—Yay or nay? Why? [49:30]; and
  • More.

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/ama09/

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Sep 30, 2019
#72 - Dan Harris: 10% happier – meditation, kindness, and compassion
02:24:36

In this episode, Dan Harris, correspondent for ABC News and co-founder of the Ten Percent Happier meditation app, speaks openly about his struggles with self-centeredness, addiction, depression, emotional volatility, and the deep-rooted insecurities that drove him to career success. He tells the story of how a panic attack on live TV lead him down a path of self-d