The Peter Attia Drive

About this podcast

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.

The Peter Attia Drive

Episodes

2021
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
AMA #18: Deep dive: sugar and sugar substitutes
In this “Ask Me Anything” (AMA) episode, Peter and Bob talk all about sugar and sugar substitutes and provide a way to think about sugar consumption. The conversation begins by defining the various forms of sugar, delineating between added sugar and naturally occurring sugar, and describing the important variables that determine the potential for metabolic damage from consumption. They then take a dive deep into three main categories of sugar substitutes—non-nutritive sweeteners, alcohol sugars, and leaving allulose, in a class by itself—including the safety profile of each, impact on blood sugar and insulin, side-effects, taste preferences, and more. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #18 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Delineating the various forms of “sugar” (2:00); Added sugar vs. naturally occurring sugar (12:30); Important variables related to sugar consumption: Density, volume, and velocity (17:00); Alternatives to sugar: Non-nutritive sweeteners (22:30); Alternatives to sugar: Alcohol sugars (34:15); Alternatives to sugar: Allulose (39:00); Contextualizing risk when it comes to sugar substitutes (45:00); Why some people report feeling better when eliminating non-nutritive sweeteners from their diet (46:30); The impact of sweetness—Cephalic insulin response and the metabolic drive to eat more (49:45); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama18/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
December 14, 2020
17 min
Gerald Shulman, M.D., Ph.D.: A masterclass on insulin resistance—molecular mechanisms and clinical implications
Gerald Shulman is a Professor of Medicine, Cellular & Molecular Physiology, and the Director of the Diabetes Research Center at Yale. His pioneering work on the use of advanced technologies to analyze metabolic flux within cells has greatly contributed to the understanding of insulin resistance and type 2 diabetes. In this episode, Gerald clarifies what insulin resistance means as it relates to the muscle and the liver, and the evolutionary reason for its existence. He goes into depth on mechanisms that lead to and resolve insulin resistance, like the role of diet, exercise, and pharmacological agents. As a bonus, Gerald concludes with insights into Metformin’s mechanism of action and its suitability as a longevity agent. We discuss: Gerald’s background and interest in metabolism and insulin resistance (4:30); Insulin resistance as a root cause of chronic disease (8:30); How Gerald uses NMR to see inside cells (12:00); Defining and diagnosing insulin resistance and type 2 diabetes (19:15); The role of lipids in insulin resistance (31:15); Confirmation of glucose transport as the root problem in lipid-induced insulin resistance (40:15); The role of exercise in protecting against insulin resistance and fatty liver (50:00); Insulin resistance in the liver (1:07:00); The evolutionary explanation for insulin resistance—an important tool for surviving starvation (1:17:15); The critical role of gluconeogenesis, and how it’s regulated by insulin (1:22:30); Inflammation and body fat as contributing factors to insulin resistance (1:32:15); Treatment approaches for fatty liver and insulin resistance, and an exciting new pharmacological approach (1:41:15); Metformin’s mechanism of action and its suitability as a longevity agent (1:58:15); More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/geraldshulman Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
December 7, 2020
129 min
Kristin Neff, Ph.D.: The power of self-compassion
Kristin Neff is a Professor of Educational Psychology at the University of Texas, author, and a leading expert on mindful self-compassion. In this episode, she shares how developing a self-compassion and mindfulness practice was the most effective tool for relieving her own suffering, and provides strategies and tactics to improve self-compassion and well-being. We discuss: The life crisis that turned Kristin to mindfulness and self-compassion (3:30); How mindful self-compassion relieved Kristin’s feelings of self-judgement, and the psychology that says we all have the capacity for self-compassion (9:45); Peter’s history of self-criticism and his personal practice of self-compassion (17:15); The problem with prioritizing self-esteem over self-compassion, and how self-compassion produces a more stable version of self-worth (20:15); An argument for self-compassion over self-criticism for optimizing performance (26:15); How and when to introduce self-compassion to children (31:45); Learning her son had autism—a personal story of how Kristin used mindfulness and self-compassion (36:45); Self-compassion for cases of childhood trauma, PTSD, and overcoming a “fear of compassion” (44:00); The relationship between self-compassion and physical health (49:30); Distinguishing between self-compassion and self-pity, and the three necessary components self-compassion (52:30); Why self-criticism comes from a desire to be safe, the circular pattern of self-judgment, and self-compassion as the ultimate motivator (55:45); Potential role of a self-compassion practice for addiction and other maladaptive behaviors (58:45); Clinical applications and practical uses of self-compassion (1:01:30); Why you don’t need to meditate to learn mindfulness and self-compassion (1:04:45); Kristin’s personal meditation practice (1:08:40); Resources for learning self-compassion (1:11:45); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/kristinneff Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
November 30, 2020
77 min
Lauren Miller Rogen and Richard Isaacson, M.D.: Alzheimer’s disease prevention—patient and doctor perspectives
Peter is joined by writer, director, actress, and founder of HFC, Lauren Miller Rogen, and previous podcast guest and director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian, Dr. Richard Isaacson. In this episode, Lauren tells the heartbreaking story of watching members of her family succumb to Alzheimer’s disease (AD) which motivated her to proactively address her own risk with Richard’s guidance. Richard discusses the various genetic and lifestyle factors that influence the risk of AD and uses Lauren’s unique situation to explain how he diagnoses patients and personalizes care. They go through Lauren’s protocol of preventative measures that have already produced marked results, and end with the uplifting message that one’s genetic predisposition does not seal one's fate. We discuss: Lauren’s deep family history of Alzheimer’s disease (3:10); The influence of genetics, epigenetics, and lifestyle on Alzheimer’s disease risk (13:45); Lauren’s mother’s disease progression and the enormous stress it causes for family members (24:30); The various manifestations of Alzheimer’s disease depending on the location of pathology (29:30); The three stages of Alzheimer's disease (34:45); Richard’s deep exploration into Lauren’s family history revealing clues about a diagnosis and a roadmap to successful disease mitigation (39:15); How exercise reduces Alzheimer’s disease risk, and the different risk between males and females (58:00); Why knowing your APOE status is important, and whether certain people should be wearier of head trauma (1:08:00); How Richard uses genetic testing to personalize care (1:14:45); The “ABCs” of Alzheimer’s prevention, lifestyle interventions, and Lauren’s personal protocol for reducing her risk (1:21:45); Unique treatment for people with the ApoE4 variant (1:36:30); Richard’s mixed opinion on CBD and THC as a tool for disease prevention (1:40:00); Cognitive testing procedures, and how Lauren’s tests furthered her commitment to her disease prevention protocol (1:41:45); The relevance of sense of smell and hearing in Alzheimer’s disease risk and prevention (1:50:00); The emotional benefit of knowing you have control over your mental and physical health (1:57:30); HFC—a charitable organization founded by Lauren and Seth (2:00:15); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/laurenmillerrogen-richardisaacson/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
November 23, 2020
132 min
Paul Offit, M.D.: An expert perspective on COVID-19 vaccines
Paul Offit is a pediatrician specializing in infectious diseases and an expert in virology and vaccine development. He currently serves on the FDA committee overseeing and evaluating COVID-19 vaccines. In this episode, Paul discusses the strategies and major companies pursuing a vaccine against the SARS-CoV-2 virus. He gets into the nuances of the vaccine approval process and its implications for COVID-19 vaccine outlook. Paul also explains potential risks, reveals his own confidence level in safety, and gives insight into protection against reinfection with vaccination. Please note that this episode was recorded 11/05/2020, prior to the 11/09/2020 news release of the Pfizer vaccine update. We discuss: How Paul’s experience as a child in a chronic care hospital as child informed his path in pediatrics and vaccine development (3:30); Addressing the anti-vaccination sentiment and explaining the fraudulent origins of the anti-vaccination movement (8:00); Lessons and insights from 26 years studying rotavirus and creating a successful rotavirus vaccine (17:00); Developing a new vaccine: the different phases of clinical trials, overall timeline, and financial costs (27:15); Operation Warp Speed: the expedited process of creating a coronavirus vaccine (32:30); Various vaccine strategies—RNA, DNA, virus vector—and the challenges associated (35:00); The Moderna and Pfizer mRNA vaccines: strategy, timeline, and Emergency Use Authorization (41:15); Paul’s confidence level in the safety of the first coronavirus vaccines (48:30); The risks associated with different types of vaccines, and updates on the Johnson & Johnson and Astrazeneca coronavirus vaccines (52:15); What we know about the coronavirus vaccines approved in Russia and China (55:45); The latest on the Merck coronavirus vaccine (57:15); The recombinant/purified protein vaccine approach for coronavirus—big players, risks, and the best vaccine for the elderly (57:45); Attenuated and inactivated vaccine strategies for coronavirus (1:02:00); The genetic drift of SARS-CoV-2: Impacts for protection and vaccine development (1:02:30); Paul’s take on the hypothesis that a previous coronavirus infection offers protection against the novel COVID-19 (1:06:45); Addressing the concern that antibodies fade over time (1:09:15); Blood type and protective against coronavirus (1:13:00); Distribution: the challenge of prioritizing the limited doses of vaccines after approval (1:13:15); Paul’s perspective on COVID-19 vaccine safety (1:16:15); Considerations regarding vaccinating children for coronavirus and the role of a fever immune response (1:21:45); Why vaccine development can be challenging and risks of current COVID-19 strategies (1:29:45); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/pauloffit Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
November 16, 2020
96 min
AMA #17: Body composition methods tour de force, insulin resistance, and Topo Chico
In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss different methods to evaluate body composition. They explore ways of measuring body fat, delineating between subcutaneous and visceral fat, and go over best strategies for improving body composition and optimizing health. They also discuss insulin resistance using a patient case study that highlights interventions capable of reversing the condition. Finally, Peter addresses his level of concern about a recent Consumer Report finding that Topo Chico had the highest levels of a class of synthetic chemicals (PFAS) of all the carbonated bottled waters tested. Peter concludes by sharing if the finding will change his consumption habits. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #17 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Body mass index (BMI) vs. body fat percentage (BF%) (1:45); Methods of assessing body fat—Magnetic Resonance Imaging (MRI) (6:25); The different types of body fat (9:00); Methods of assessing body fat—Computed Tomography (CT Scan) (12:00); Methods of assessing body fat—Dual-Energy X-ray Absorptiometry (DEXA) (14:30); Methods of assessing body fat—Hydrostatic/Underwater Weighing (19:25); Methods of assessing body fat—Air Displacement (Bod Pod) (22:25); Methods of assessing body fat—Skinfold measurement (23:55); Methods of assessing body fat—Total Body Water (27:15); Methods of assessing body fat—Bioelectrical Impedance (BIA) (28:45); The optimal body fat percentage, muscle mass, and the best strategy to improve body composition (31:30); Defining insulin resistance and the steps to reverse it (40:15); Patient case study: Reversing insulin resistance (49:00); Addressing the recent finding of high levels of PFOA in Topo Chico (58:25); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama17 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
November 9, 2020
19 min
BJ Miller, M.D.: How understanding death leads to a better life
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. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/bjmiller 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.
November 2, 2020
115 min
James O’Keefe, M.D.: Preventing cardiovascular disease and the risk of too much exercise.
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. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/JamesOKeefe 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.
October 26, 2020
130 min
Vinay Prasad, M.D., M.P.H: Hallmarks of successful cancer policy
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. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/VinayPrasad 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.
October 19, 2020
133 min
AMA #16: Exploring hot and cold therapy
In this “Ask Me Anything” (AMA) episode, Peter and Bob explore the quality of evidence for hot and cold therapy. In the discussion, they evaluate the safety, efficacy, and opportunity costs of various hot and cold therapy protocols, and Peter ultimately considers the addition of dry sauna to his longevity toolkit. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #16 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: How stress can show up as physical pain, and tips for changing time zones [1:45]; Literature overview of heat and cold therapy [7:15]; Cold therapy for delayed onset muscle soreness (DOMS) [12:00]; Quality of evidence for cold therapy for depression or immune enhancement [19:30]; Cold therapy and brown adipose tissue (BAT) [21:15]; Weighing the safety, efficacy, and opportunity cost of cold therapy [28:45]; An overview of heat therapy benefits [40:00]; Longevity benefits of sauna—reviewing the studies [41:30]; Limitations in the sauna literature—Where might we be fooled? [54:30]; Possible mechanisms conferring the longevity benefits of sauna, and how it compares to exercise [1:02:15]; Parting thoughts on sauna, opportunity costs, and Bob’s personal regimen [1:06:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama16/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
October 12, 2020
20 min

The Peter Attia Drive

About this podcast

Categories

About this podcast

Categories

The Peter Attia Drive

Episodes

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

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

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

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

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

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

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

Phil Maffetone: Optimizing health and performance through maximal aerobic function

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

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

AMA #18: Deep dive: sugar and sugar substitutes

Gerald Shulman, M.D., Ph.D.: A masterclass on insulin resistance—molecular mechanisms and clinical implications

Kristin Neff, Ph.D.: The power of self-compassion

Lauren Miller Rogen and Richard Isaacson, M.D.: Alzheimer’s disease prevention—patient and doctor perspectives

Paul Offit, M.D.: An expert perspective on COVID-19 vaccines

AMA #17: Body composition methods tour de force, insulin resistance, and Topo Chico

BJ Miller, M.D.: How understanding death leads to a better life

James O’Keefe, M.D.: Preventing cardiovascular disease and the risk of too much exercise.

Vinay Prasad, M.D., M.P.H: Hallmarks of successful cancer policy

AMA #16: Exploring hot and cold therapy