Episodes

• 2021

• AMA #23: All Things Nicotine: deep dive into its cognitive and physical benefits, risks, and mechanisms of action

  In this “Ask Me Anything” (AMA) episode, Peter and Bob dive deep into nicotine, a complicated and interesting molecule that has effects on both the brain and the body. They analyze the results of the studies that describe nicotine’s cognitive benefits and potential for inducing weight loss. They talk about a smoking cessation technique called nicotine replacement therapy and give a full breakdown of the various routes of administration, dosing, and safety. Finally, they explore the fascinating and counterintuitive observation that cigarette smokers are less likely to get a severe case of COVID-19. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #23 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: How Peter first became interested in the potential benefits of nicotine [1:15]; Untangling nicotine from tobacco [6:00]; Nicotine replacement therapy (NRT) for quitting smoking: products, protocols, and a review of the literature [9:30]; The cognitive benefits of nicotine: Overview of the literature [15:50]; Where nicotine has the most positive impact on cognition [30:30]; Possible mechanisms conferring the benefits of nicotine [37:00]; How modafinil and other nootropics compare to nicotine [47:15]; How nicotine may induce weight loss [54:00]; Relationship between smoking and COVID-19: Analyzing the observation that smoking appears protective against COVID-19 [1:01:45]; Breakdown of the various nicotine replacement therapies: route of administration, dosing, and safety [1:11:30]; Concluding thoughts on nicotine: use cases, addictive properties, and more [1:19:45]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama23 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  May 10, 2021

  20 min

• Paul Offit, M.D.: The latest on COVID-19 vaccines and their safety, herd immunity, and viral variants

  Paul Offit is a pediatrician specializing in infectious diseases and an expert in virology and vaccine development. He currently serves on the FDA committee evaluating COVID-19 vaccines. In this episode, Paul’s second appearance on The Drive, he provides an update on all the SARS-CoV-2 vaccines currently deployed, explains why the concerns raised around the mRNA vaccines are not legitimate, and offers his view on the prospects and timeframe of reaching herd immunity. He also takes a deep dive into immunology, explaining the short-term and long-term immune response to both natural infection and vaccination and how these two can function together to provide durable immunity. Additionally, they discuss the theories on the origins of this virus, what impact the new COVID-19 variants might have, and the recent pausing of the J&J vaccine. Finally, they discuss how we can be better prepared for an inevitable future outbreak of a novel virus. This episode was originally recorded on April 14, 2021. We discuss: Overview and current status of the SARS-CoV-2 vaccine strategies [4:10]; Addressing concerns about mRNA vaccines [9:00]; How the failure to make an effective HIV vaccine aided the development of a COVID-19 vaccine [16:45]; Where SARS-CoV-2 falls on the spectrum of its ability to mutate and what that means for immunity and vaccination [21:30]; How the combination of short-term and long-term immune response to SARS-CoV-2 work together to provide durable immunity [28:00]; Importance of understanding relative vs. absolute risk reduction [38:15]; Implications of pausing the J&J vaccine due to reports of blood clotting in the brain [42:45]; What constitutes herd immunity and the concerns of rising vaccine hesitancy [47:45]; When we might reach herd immunity, future vaccines for children, and long-term outlook for maintaining population immunity [58:45]; Theories about the origins of SARS-CoV-2 [1:07:00]; Preparing for the possibility of a future pandemic and how we can learn from our mistakes [1:10:40]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/pauloffit2 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  May 3, 2021

  86 min

• Peter Hotez, M.D., Ph.D.: Evolution of the anti-vaccine movement, the causes of autism, and COVID-19 vaccine state of affairs

  Peter Hotez is an internationally recognized physician-scientist in neglected tropical diseases and vaccine development. In this episode, they first follow up on the podcast episode (#158) with Brian Deer (the investigative journalist who exposed the complex and disturbing story behind the infamous 1998 Lancet paper by Andrew Wakefield linking the MMR vaccine and autism) with a broader discussion about the origin and evolution of the anti-vaccine movement. They explore some of the specific claims being made around vaccine additives, the timing of when vaccines are given, and claims about issues with the HPV vaccine specifically. Next, Dr. Hotez shares his own journey as a parent of an autistic child and speaks of the challenges of diagnosing autism, what could account for the seeming increase in the prevalence, and whether there is any support for the notion that environmental triggers play a role. They close out with a discussion on the state of affairs with respect to COVID-19 vaccination, comparing the various vaccines as well as the challenges that emerging variants of the virus may present. This episode was originally recorded on April 2, 2021. We discuss: The stubborn persistence of anti-vaccine sentiment (3:00); A closer look at claims about thimerosal and vaccine spacing causing autism (12:00); The Hib vaccine: An example of the profound difference a vaccine can make (23:30); The controversy surrounding the human papillomavirus (HPV) vaccine (30:45); The growing anti-science sentiment, COVID vaccine hesitance, and the basis of the anti-vaxx movement (39:00); The origins of autism, and Hotez’s personal story as a parent of an autistic child (1:02:45); The challenge of diagnosing autism, increasing prevalence, and a potential parallel to Alzheimer’s disease (1:14:15); Comparing the various COVID-19 vaccines and the impact of emerging variants of the virus (1:30:00); Global vaccination challenges and “vaccine diplomacy” (1:40:45); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/PeterHotez3 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  April 26, 2021

  115 min

• Brian Deer: A tale of scientific fraud—exposing Andrew Wakefield and the origin of the belief that vaccines cause autism

  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. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/BrianDeer Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  April 19, 2021

  110 min

• AMA #22: Losing fat and gaining fat: the lessons of fat flux

  In this “Ask Me Anything” (AMA) episode, Peter and Bob take a deep dive into fat flux. They define the major players that impact the flow of fat entering and exiting a fat cell, which determines how much fat a person carries. They discuss the significant influence that insulin has on the net fat balance and explore common strategies, such as fasting and low-carb diets, that have efficacy in the liberation and oxidation of fat from fat cells. Additionally, Bob explains his research process and how he seeks answers to Peter’s challenging questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #22 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: The two main ways to reduce fat mass (1:30); Explaining fat flux—how fat enters and exits a fat cell (9:15); What fat balance looks like (21:15); What net fat influx looks like, and the impact of insulin in lipolysis (24:30); What net fat efflux looks like, and the benefits of fasting to break the hyperinsulinemic cycle (28:30); Exploring why most people with excess body fat will lose fat mass when reducing carbohydrates or eating a ketogenic diet (32:45); Why being in nutritional ketosis does not automatically translate to negative fat flux (fat loss) (42:40); Bob’s approach to scientific research (47:00); The importance of curiosity and a desire to learn (58:30); Bob’s tips and tricks for answering a scientific question in a time-crunch (1:00:00); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama22/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  April 12, 2021

  16 min

• Jake Muise: Humanely harvesting axis deer while alleviating its impact on Hawaii’s vulnerable ecosystems

  Jake Muise is an avid hunter, environmentalist, and advocate for the preservation of Hawaii’s natural resources. He is the founder of Maui Nui Venison, a company which actively manages Hawaii’s imbalanced population of axis deer by harvesting them as a food resource. In this episode, Jake tells his unbelievable backstory growing up in Northern Alberta before landing in Hawaii on a volleyball scholarship where he fell in love with the islands and the people. Jake explains how axis deer—a non-native species—were brought to the islands and how they have since become imbalanced to the detriment of Hawaii’s precious ecosystems. He goes on to explain the incredible lengths that his company has taken to ensure the most humane harvesting techniques imaginable resulting in a food source that is as clean and healthful as can be. Additionally, Jake and Peter examine what makes meat from axis deer one of the most nutrient-dense red meats on the planet. We discuss: Upbringing in Northern Alberta, a diet of moose meat, and learning to surf in Nova Scotia (3:35); How volleyball brought Jake to Hawaii where he met the Molokai people (14:00); Jake’s introduction to axis deer (26:30); Pro volleyball in Europe, missing the Olympic team by one spot, and his return to Hawaii (29:00); History of axis deer in Hawaii—how a non-native species came to the islands, and the superpowers that make them so hard to hunt (34:00); A potential catastrophe avoided on The Big Island—The amazing story of how Jake tracked and found axis deer that were secretly brought to The Big Island (52:15); Jake’s work helping ranchers on Maui (1:08:15); The detrimental impact of an imbalanced axis deer population (1:10:30); The incredible evacuation of farm animals from lava-locked land due to a volcano eruption (1:17:00); The creation of Maui Nui Venison—going above and beyond USDA requirements (1:27:00); The most humane way to harvest an animal—the unmatched standards Maui Nui Venison uses to harvest axis deer (1:32:00); Why meat from axis deer is nutritionally superior (and tastes better) than other meats (1:46:00); Why axis deer meat is the best option for those reluctant to eat meat: True nose-to-tail nutrition and ethical harvesting (1:58:15); What a truly balanced population of axis deer on Hawaii would look like (2:06:15); Maui Nui Venison’s charitable work during the COVID crisis (2:12:45); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/jakemuise Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  April 5, 2021

  140 min

• Chris Sonnenday, M.D.: The history, challenges, and gift of organ transplantation

  Chris Sonnenday is the Transplant Center Director for Michigan Medicine. As Peter’s senior resident while at Johns Hopkins, Chris made a lasting impression on him with his remarkable leadership and ability to maintain his humanity through the stressors of that challenging environment. In this episode, Chris tells the incredible backstory of the history of transplant medicine, focusing on the kidney and the liver. He discusses the surgical and immunologic developments that launched the field forward, but also lays out the challenges ahead for the field, such as the rising prevalence of chronic kidney and liver failure. Chris also tells many stories of tragedy and triumph that comes with working in organ transplantation, but ultimately explains the rewarding nature of being a witness to the gift of organ donation. We discuss: What attracted Chris to medicine, and his leadership in residency (3:30); How Chris maintained his empathy and humanity through the stresses of med school and residency (8:30); Why Chris chose a complicated field like transplant medicine (23:15); Explaining kidney transplantation to showcase the challenge of organ transplantation surgery (28:00); Overcoming the immune-based challenges of transplant surgery (37:00); How the discovery of cyclosporine transformed the field of organ transplantation (49:00); Rising chronic kidney failure due to the prevalence of pre-diabetes and metabolic syndrome (53:45); Why living kidney donations are superior, and the possibility of a market for kidney donation (59:30); Designing a fair system of organ distribution (1:17:30); The debate on what constitutes “death” when deciding when to take organs from a registered organ donor (1:21:45); Reflections on the gift of organ donation (1:33:15); The history of liver transplantation and why it’s so complex (1:39:15); Addressing acute liver failure and the amazing baboon experiment (1:46:15); The potential for the rising prevalence of NAFLD and NASH to overwhelm the liver transplant infrastructure in the US (1:54:45); The importance of teamwork in successful organ transplantations, and the most tragic event Chris has ever witnessed (2:05:45); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: http://peterattiamd.com/ChrisSonnenday Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  March 29, 2021

  135 min

• Steve Levitt, Ph.D.: A rogue economist’s view on climate change, mental health, the ethics of experiments, and more

  Steven Levitt is a professor of economics at the University of Chicago and the co-author of the bestselling book Freakonomics and its two sequels. In this episode, Steve discusses his unlikely path to a career in economics and his view of the current state, and limitations, of the field. He also gives his unique perspective on contemporary issues including climate change, mental health in education, how to evaluate whether an experiment is ethical, decision making, horse racing, and much more. We discuss: How Steve ended up in economics (2:45); Current trends in the field of economics: macro vs. micro, usefulness of models, and the relationship between data and theory (8:45); Revisiting what Steve wrote about climate change in SuperFreakonomics, and why it’s unlikely to be solved with behavioral change (18:45); The consequences of a blurred line between climate science and advocacy (27:30); Answering climate questions with a “Manhattan Project for climate change” (31:45); Steve’s reflections on his career path and how he found his way by being himself (40:00); How Steve came to write Freakonomics (and its sequels), and the topics which caused the most controversy (53:00); How Steve came to appreciate mental health through parenting, and the need to emphasize mental health into the education system (1:10:15); Why people are bad at making decisions (1:26:45); Deliberating on why horse racing times haven’t advance much in decades (1:34:30); Reducing the impact of negative emotions by observing the world free of language (1:44:00); Changing our thinking about what it means to conduct experiments ethically (1:49:00); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/SteveLevitt Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  March 22, 2021

  121 min

• AMA #21: Deep dive into olive oil, high-intensity exercise, book update, and more

  In this “Ask Me Anything” (AMA) episode, Peter and Bob take a deep dive into olive oil. They explore the history of olive oil, discuss observational data that led to the hypothesis that olive oil is a healthier alternative to many other fats, and they explain the classification of olive oil types —including what to look for in a high-quality “extra virgin” olive oil. Peter and Bob round out the discussion with a “two-minute drill,” in which Peter answers questions from subscribers. They cover zone 5 training, an update on Peter’s book, lactate meters, standing desks, massage guns, electrolyte supplementation, and more. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #21 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: The early history of olive oil and the Mediterranean diet (2:15); The three broad categories of fats: SFA, MUFA, and PUFA (6:25); Exploring the hypothesis that olive oil is healthy (10:30); Comparing olive oil to the makeup of other common oils (30:00); Defining “extra virgin” olive oil, what to look for when purchasing, and Peter’s favorite brand (34:30); Update on Peter’s book (47:15); Zone 5 training: Peter's approach to zone 5 training, and other anaerobic training protocols (49:30); Advantages of using a standing desk compared to sitting (55:30); Lactate meters and strips (57:45); Electrolyte supplementation during fasting and ketosis, and why uric acid may increase (59:30); The usefulness of massage guns, foam rollers, and professional massage for muscle pain and tightness (1:01:30); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama21/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  March 15, 2021

  15 min

• Michael Rintala, D.C.: Principles of Dynamic Neuromuscular Stabilization (DNS)

  Michael Rintala is a sports medicine chiropractor and one of only 18 international instructors teaching dynamic neuromuscular stabilization (DNS) for the Prague School of Rehabilitation. This episode focuses on understanding DNS, including the foundational principles and how it relates to human motor development. Michael also shares the most common injuries and issues he sees in patients in his practice, such as postural problems and back pain, and how the movements of a DNS program are used to avoid injury, maintain longevity, and improve sports performance. We discuss: Michael’s background in chiropractic sports medicine and rehabilitation (3:15); The Prague School of Rehabilitation, and functional rehabilitation as the foundation of the dynamic neuromuscular stabilization (DNS) program (5:00); Foundational principles of DNS, and the role of the diaphragm in muscular stability (19:00); Types of muscle contractions (28:15); Human motor development through the lens of DNS, and when issues begin to arise (32:30); Common postural syndromes (50:00); Increasing functional threshold to minimize time in the functional gap (56:45); DNS for injuries, pain, pre-habilitation, and performance enhancement (1:03:45); Etiology of back pain (1:10:00); How a stress fracture in his back led Michael to the Prague School (1:16:00); The Prague School curriculum: 3 tracks for certification in DNS (1:20:45); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/MichaelRintala/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  March 8, 2021

  96 min

• Alex Hutchinson, Ph.D.: Translating the science of endurance and extreme human performance

  Alex Hutchinson is a sports science journalist, author of the book Endure—which explores the science of endurance and the real limits of human performance—and former competitive runner for the Canadian national team. In this episode, Alex tells the story of his “aha moment” during a meaningless track meet that catapulted his running career and seeded his interest in the power of the mind. He then explains the science behind VO2 max, the difference between maximum aerobic capacity and efficiency, and extracts insights from examples of extreme human performance, such as the recent attempts to break the 2-hour mark in the marathon. Finally, he brings it back to what this all means for the everyday person: optimal exercise volume for maintaining health, how to avoid acute and chronic injuries, how to diversify your exercise portfolio, HIIT protocols, and much more. We discuss: Alex’s background and passion for running (3:00); The power of the mind: Alex’s “aha moment” that catapulted his running career (9:00); Pursuing a Ph.D. in physics while prioritizing his running career, and doing the hardest thing possible (19:00); Career transition to journalism, tips for improving your writing, and insights from the best writers (26:00); Breaking down VO2 max: Definition, history, why it plateaus, and whether it really matters (38:15); The case study of Oskar Svensson: Why a higher VO2 Max isn’t always better, and the difference between maximum aerobic capacity and efficiency (49:15); The sub 2-hour marathon: The amazing feat by Kipchoge, and what will it take to “officially” run a 2-hour marathon (1:01:00); Comparing the greatest mile runners from the 1950s to today (1:14:45); How the brain influences the limits of endurance (1:20:15); Relationship between exercise volume and health: Minimum dose, optimal dose, and whether too much exercise can shorten lifespan (1:23:45); Age-associated decline in aerobic capacity and muscle mass, and the quick decline with extreme inactivity (1:40:45); Strength or muscle mass—which is more important? (1:47:00); Avoiding acute and chronic injuries from exercise (1:48:45); High intensity interval training: Evolution of the Tabata protocol, pros and cons of HIIT training, and how it fits into a healthy exercise program (1:54:15); The importance of understanding why you are engaging in exercise (2:03:00); How we can encourage better science journalism and reduce the number of sensationalized headlines (2:05:45); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/AlexHutchinson Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  March 1, 2021

  134 min

• Senator Bill Frist, M.D.: A modern Renaissance man's journey through science, politics, and business

  Bill Frist is a nationally acclaimed heart and lung transplant surgeon, former U.S. Senate Majority Leader, and is actively engaged in health policy and education reform. In this episode, Bill takes us through his long and varied career in medicine, politics, and business, which includes establishing the organ transplantation program at Vanderbilt as well as rising from the lowest-ranked member of the U.S. Senate to the Majority Leader in two terms. We discuss some of the most significant moments of his time in the Senate, such as advocating for AIDS prevention programs' funding and addressing complicated issues like stem cell research and the end-of-life issues raised by the Terri Schiavo case. We also hear his first-person account of what happened behind the scenes on September 11, 2001, his frustration with our lack of preparation for the pandemic, and his thoughts about the current state of U.S. politics. Finally, we talk about his current endeavors in health policy and education reform. We discuss: Bill’s decision to pursue medicine and do organ transplants (3:40); The miraculous nature of organ transplants: History, Bill’s work, and the most exciting things to come (12:00); Frist’s experience building up the heart transplant program at Vanderbilt (21:45); The famous rivalry between surgeons Denton Cooley and Michael DeBakey (29:15); How the medical field can attract bright young people to pursue medicine (33:00); Bill’s decision to leave medicine and run for the US senate (38:00); The value in having scientists and physicians in Congress (47:30); A discussion on whether or not senators should have term limits (55:30); The highly polarized nature of politics, and how we can fix it with empathy (1:00:30); Bill’s time in the Senate and quick rise to Senate Majority Leader (1:05:30); The lifesaving impact of the President's Emergency Plan for AIDS Relief (PEPFAR) under George W. Bush (1:15:15); How Bill reversed course on his view of the value and morality of stem cell research (1:19:45); Complex end-of-life decisions, and Bill’s role in the infamous Terri Schiavo case—a story that captures the conflict among law, morality, and improving technology (1:30:00); Remembering the events of September 11th from Bill’s perspective in the Senate (1:49:45); The coronavirus pandemic: Bill’s accurate 2005 prediction, and a discussion about future preparedness (1:56:45); The divided state of US politics, and how we can come together (2:06:45); How experience in medicine and politics is shaping Bill’s current endeavors in business, reforming education, palliative care, and more (2:12:45); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/BillFrist Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  February 22, 2021

  144 min

• 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

  In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss all things related to insulin resistance by revisiting the important points made in the fascinating, yet quite technical, episode of The Drive with Gerald Shulman. They devote the entire discussion to understanding the condition known as insulin resistance, how it’s measured, how it manifests in the muscle and liver, and ultimately, what we can do about it. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #20 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Explaining the format of this AMA: Extracting insights from Gerald Shulman’s masterclass on insulin resistance (2:00); The basics of insulin, defining insulin resistance (IR), and gold-standard methods of quantifying IR in the muscle (7:15); Practical ways to test for insulin resistance in a normal clinical setting (15:45); How insulin resistance manifests in the muscle (23:00); The biochemical block in glycogen synthesis—drivers and mechanisms resulting in insulin resistance in the muscle (30:45); The disparity in fat oxidation between insulin-sensitive and insulin-resistant individuals (44:45); The fate of the ingested carbohydrate in someone who is insulin resistant (51:00); The prevalence and clinical phenotype of insulin resistance (1:00:15); The role of exercise in mitigating and reversing insulin resistance (1:05:00); How insulin resistance manifests in the liver (1:09:15); Biggest takeaways: what we can do to mitigate and prevent insulin resistance (1:20:45); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama20/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  February 15, 2021

  24 min

• Richard Miller, M.D., Ph.D.: The gold standard for testing longevity drugs: the Interventions Testing Program

  Richard Miller is a professor of pathology and the Director of the Center for Aging Research at the University of Michigan. He is one of the architects of the NIA-funded Interventions Testing Programs (ITPs) animal study test protocol. In this episode, Rich goes through the results of the long list of molecules tested by the ITP—including rapamycin, metformin, nicotinamide riboside, an SGLT-2 inhibitor called canagliflozin, and more. Many of the discussed outcomes have had surprising outcomes—both positive and negative findings. We discuss: Rich’s interest in aging, and how Hayflick’s hypothesis skewed aging research (3:45); Dispelling the myth that aging can’t be slowed (15:00); The Interventions Testing Program—A scientific framework for testing whether drugs extend lifespan in mice (29:00); Testing aspirin in the first ITP cohort (38:45); Rapamycin: results from ITP studies, dosing considerations, and what it tells us about early- vs. late-life interventions (44:45); Acarbose as a potential longevity agent by virtue of its ability to block peak glucose levels (1:07:15); Resveratrol: why it received so much attention as a longevity agent, and the takeaways from the negative results of the ITP study (1:15:45); The value in negative findings: ITP studies of green tea extract, methylene blue, curcumin, and more (1:24:15); 17α-Estradiol: lifespan effects in male mice, and sex-specific effects of different interventions (1:27:00); Testing ursolic acid and hydrogen sulfide: rationale and preliminary results (1:33:15); Canagliflozin (an SGLT2 inhibitor): exploring the impressive lifespan results in male mice (1:35:45); The failure of metformin: reconciling negative results of the ITP with data in human studies (1:42:30); Nicotinamide riboside: insights from the negative results of the ITP study (1:48:45); The three most important takeaways from the ITP studies (1:55:30); Philosophies on studying the aging process: best model organisms, when to start interventions, which questions to ask, and more (1:59:30); Seven reasons why pigs can't fly (2:08:00); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/RichardMiller Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  February 8, 2021

  135 min

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

  Hussein Yassine is a physician and researcher who studies brain lipid utilization in the context of finding preventative measures for cognitive impairment, specifically Alzheimer’s disease (AD). In my conversation with Hussein, we begin with a fundamental coursework in brain biology—including its architecture and energy systems. We go on to discuss what these systems look like when something goes wrong and cognitive decline ensues. We talk about the evolutionary origins of the ApoE genotype, with specific attention to the ApoE4 allele and its association with AD. We spend time discussing ApoE4 implications for the brain’s fuel utilization, notably omega-3 fatty acids: EPA and DHA. We briefly pivot to the implications of recent omega-3 trials for cardiovascular disease and return to what we currently understand about EPA/DHA and brain health; we contemplate potential dietary interventions across the lifespan to preserve and prolong cognitive function. We discuss: Hussein’s Background and introduction to brain composition (3:00); The blood-brain barrier and brain filtration (8:00); Lipids and brain function (13:00); How the brain utilizes energy (18:00); Apolipoprotein E (ApoE) structure and function in the periphery (27:30); ApoE function in the brain (38:15); Evolutionary origins of ApoE isoforms (43:45); ApoE4 variant and Alzheimer’s disease (AD) risk (53:30); Dietary fuel preference with the ApoE4 allele (1:03:00); The role of omega-3 fatty acids in the brain (1:13:30); Comparing findings from the REDUCE-IT and STRENGTH trial (1:21:45): The relationship between dietary omega-3 intake and brain health (1:34:15); Preventing cognitive decline: A critical window for DHA in ApoE4 carriers? (1:42:30); Hussein’s ongoing research and recommendations for E4 carriers (1:54:00); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/HusseinYassine Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  February 1, 2021

  127 min

• Guy Winch, Ph.D.: Emotional first aid and how to treat psychological injuries

  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. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/guywinch Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  January 25, 2021

  118 min

• AMA #19: Deep dive on Zone 2 training, magnesium supplementation, and how to engage with your doctor

  In this “Ask Me Anything” (AMA) episode, Peter and Bob take a deep dive into zone 2 training. They begin with a detailed definition of zone 2 and continue by discussing the importance of adding it to your exercise regimen. They talk about how to program zone 2 training, including intensity, frequency, and duration, and metrics for tracking improvement. Additionally, they provide a detailed overview of all things related to magnesium supplementation. The two conclude with insights about how to effectively engage with your doctor in the pursuit of getting your questions answered and considerations for finding a physician that’s right for you. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #19 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Defining zone 2 exercise (3:30); The most effective ways to engage in zone 2 exercise (14:00); The process of training a deconditioned individual with zone 2: Dosage, frequency, and metrics to watch (19:45); Training for health vs. performance, and the importance dedicating training time solely to zone 2 (25:00); Why Peter does his zone 2 training in a fasted state (31:30); Improving mitochondrial density and function with zone 2 training (34:00); Metrics to monitor improving fitness levels from zone 2 training (36:30); Advice for choosing a bicycle for zone 2 exercise at home (42:30); Comparing the various equipment options for aerobic training: Rowing machine, treadmill, stairmaster, and more [48:15]; Back pain and exercise, and Peter’s stability issues as a consequence of previous surgeries (51:45); A deep dive into magnesium supplementation, and Peter’s personal protocol (55:30); Advice for engaging with and questioning your doctor (1:03:15); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama19 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  January 18, 2021

  18 min

• Phil Maffetone: Optimizing health and performance through maximal aerobic function

  Phil Maffetone is an author, health practitioner, and coach with decades of experience helping everyone from amateurs to world-class athletes optimize their health and performance. In this episode, Phil explains the importance of developing the aerobic system, defines maximum aerobic function (MAF), and explains how to determine your MAF heart rate. He then demonstrates how to integrate that into a training protocol which is designed to help people move faster at a sub maximum heart rate and increase fat utilization as the primary source of fuel—emphasizing the importance of nutrition on one's capacity to oxidize fat. Phil also extracts training insights from the amazing feats of world-class marathoners, explores the impact of a low-carb diet on one’s capacity for high intensity exercise and anaerobic performance, and explains the downstream effects of being “overfat.” We discuss: Phil’s background in running, and training insights from a six-day race (2:30); The difference between being “fit” and being “healthy” (11:00); Defining the aerobic and anaerobic systems, and why VO2 max doesn’t predict performance (18:15); Defining maximum aerobic function (MAF), determining your MAF heart rate with Phil’s 180 Formula, and why a strong aerobic system is crucial to health and performance (24:00); Using the MAF test to track and improve your aerobic fitness (37:30); How increasing your sub-max pace at a given heart rate can increase your maximum pace (40:00); The impact of nutrition on one’s ability to use fat as fuel while exercising (43:00); Phil’s nutritional approach with patients, the concept of “carbohydrate intolerance” (51:45); Assessing the impact of a low-carb diet on high intensity exercise and anaerobic performance (58:00); Extracting insights from world-class marathoners (1:04:45); How being “overfat” affects health and performance, and ways to decrease excess body fat (1:13:30); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: http://peterattiamd.com/PhilMaffetone Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  January 11, 2021

  83 min

• John Ioannidis, M.D., D.Sc.: Why most biomedical research is flawed, and how to improve it

  John Ioannidis is a physician, scientist, writer, and a Stanford University professor who studies scientific research itself, a process known as meta-research. In this episode, John discusses his staggering finding that the majority of published research is actually incorrect. Using nutritional epidemiology as the poster child for irreproducible findings, John describes at length the factors that play into these false positive results and offers numerous insights into how science can course correct. We discuss: John’s background, and the synergy of mathematics, science, and medicine (2:40); Why most published research findings are false (10:00); The bending of data to reach ‘statistical significance,’ and the how bias impacts results (19:30); The problem of power: How over- and under-powered studies lead to false positives (26:00); Contrasting nutritional epidemiology with genetics research (31:00); How to improve nutritional epidemiology and get more answers on efficacy (38:45); How pre-existing beliefs impact science (52:30); The antidote to questionable research practices infected with bias and bad incentive structures (1:03:45); The different roles of public, private, and philanthropic sectors in funding high-risk research that asks the important questions (1:12:00); Case studies demonstrating the challenge of epidemiology and how even the best studies can have major flaws (1:21:30); Results of John’s study looking at the seroprevalence of SARS-CoV-2, and the resulting vitriol revealing the challenge of doing science in a hyper-politicized environment (1:31:00); John’s excitement about the future (1:47:45); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/JohnIoannidis Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  January 4, 2021

  113 min
• 2020

• Robert Abbott: The Bobby Knight story—a cautionary tale of unchecked anger, ego, and winning at all costs

  Robert Abbott is a six-time Emmy award winner and the director of “The Last Days of Knight,” the behind-the-scenes documentary of legendary coach Bobby Knight, and the events that led to his termination from Indiana University. In this episode, Robert takes us through his investigative journey, which revealed cautionary tales of a winning at all costs environment—how pain often gets left in the wake of unchecked anger, ego, and perfectionism. Robert reflects on Knight’s legacy and extracts lessons in self-awareness and accountability that can be applied to ensure history doesn’t repeat itself. We discuss: Robert’s career covering sports and interesting athletes (2:30); Robert’s early impression of Bobby Knight’s controversial persona (10:15); The journalistic work that uniquely prepared Robert for his Bobby Knight story (13:30); The cost of excellence in sports—cautionary tales of ‘greatness at any cost’ (19:15); Knight’s coaching style, waning success in the 90s, and what put him on Robert’s radar (25:30); Three alarming accounts from a former player (Neil Reed) that launched Robert’s investigation into Bobby Knight (35:15); The “win-first” environment at Indiana that provided cover for Knight’s toxic behavior (44:45); Knight’s ego swells—a shift from team-first to “I” and “me” (53:00); How patience, honesty, and gaining trust with his sources paid off in his reporting on Bobby Knight (1:01:30); The vicious cycle and anger and shame, and why Bobby Knight is so interesting to Peter (1:08:00); Releasing the choking tape—Breaking open the Knight story, vindicating his earlier reporting, and the most powerful moment Robert has ever witnessed in his journalistic career (1:20:00); The bittersweet story of Neil Reed—triumph, PTSD, and breaking the cycle of pain (1:43:15); Examining Bobby Knight's legacy, and how society can avoid a repeat of similar devastating situations (1:57:30); Final thoughts on Bobby Knight and the pain left in his wake (2:08:00); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/RobertAbbott Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
  December 21, 2020

  135 min