The Peter Attia Drive

Peter Attia, MD

The Peter Attia Drive will feature guests and experts that will offer advice and insight to help you optimize performance, health, longevity, critical thinking, and life. It’s hosted by Stanford M.D., TED speaker, and longevity expert Dr. Peter Attia, founder of Attia Medical, PC, a medical practice with offices in San Diego and New York City.

#225 ‒ The comfort crisis, doing hard things, rucking, and more | Michael Easter, MA
Yesterday
#225 ‒ The comfort crisis, doing hard things, rucking, and more | Michael Easter, MA
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Michael Easter is the author of the bestseller, The Comfort Crisis. He’s also a journalist, Professor of Journalism at UNLV, and a leading voice on how humans can integrate modern science and evolutionary wisdom for improved health, meaning, and performance in life and at work. In this episode, Michael first talks about his upbringing, including his parents' struggle with alcoholism, his father leaving when he was young, and how these things impacted Michael's own struggle with alcoholism. He explains what led to his realization that we are in a “crisis of comfort” and how the removal of many of life’s discomforts through advancements in modern society may actually be a leading contributor to many of our most urgent physical and mental health issues. He explains the benefits of challenging oneself and the immense positive carryover which can come from doing things we find difficult. He describes the consequences of technology like smartphones, which have effectively eliminated boredom—a discomfort that comes with many benefits. He tells the story of a profound experience at an elk hunt that changed Michael’s thoughts around life and death, how happiness can thrive in places without all of the modern comforts of the West, and why we’re hardwired for stress and what to do about it. They conclude with a conversation around rucking, an activity with many physical and mental benefits. We discuss: The value in doing something difficult [2:30];Michael’s upbringing with a single parent and alcoholism [5:45];Michael’s battle with alcoholism and his experience with quitting drinking [10:00];Origin of the idea that we are in a crisis of comfort [20:30];The death of boredom in modern society [28:45];The benefits of boredom [36:00];The value of disconnecting and being in nature [39:15];Changing the dynamic of how we think about food and the story of Peter’s daughter’s first hunt [43:45];How a profound experience at an elk hunt changed Michael’s thoughts about life and death [49:15];How happiness can thrive in places without all of the modern comforts of the West [57:15];Why we’re hardwired for stress, and the responsibility that comes with our level of comfort [1:05:30];How perspective on the timescale of our lives in relation to history can impart positive changes [1:14:00];The benefit of challenging oneself and the positive carryover it can have [1:19:45];The many benefits of rucking [1:28:45];Tips for rucking: ideal load, type of pack, and other considerations [1:38:00];Parting thoughts on the downside of comfort and benefits of difficult things [1:43:00]; andMore. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#224 ‒ Dietary protein: amount needed, ideal timing, quality, and more | Don Layman, Ph.D.
Sep 26 2022
#224 ‒ Dietary protein: amount needed, ideal timing, quality, and more | Don Layman, Ph.D.
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Don Layman is a Professor of Food Science and Human Nutrition at the University of Illinois Urbana-Champaign. He has spent the past 40 years investigating the role of dietary protein in muscle protein synthesis. In this episode, Don describes how his decades of research have shaped his thinking around protein, muscle, anabolic factors, metabolism, and more. He explains the recommended dietary allowance (RDA) for protein: what it is, how it came about, and how it should serve only as a guide for the minimum protein necessary for survival rather than as an optimal level of protein intake. He provides an overview of the essential amino acids, explains the nuances of animal versus plant protein, and provides insights for determining protein quality, absorption rates, and how to best track your intake. He discusses the ideal timing of protein intake in relation to resistance exercise, how protein should be distributed among meals, and how limitations in protein utilization per sitting can impact those practicing time-restricted eating. Additionally, Don shares results from his clinical trials, including how a high-protein diet fared in terms of fat loss, and explains the differences in protein utilization between adolescents and adults and how the problem of reduced efficiency of protein utilization in older adults can be overcome. We discuss: Don’s background: from growing up on a farm to studying nutritional biochemistry [2:30];Don’s philosophy on nutrition, muscle, and metabolism [6:30];The controversial relationship between saturated fat and atherosclerosis [18:15];The basics of protein and amino acids [25:45];Origin and limitations of the current recommended dietary allowance (RDA) for protein intake [32:15];Protein sources: determining quality, absorption rates, and how to track intake [41:15];Leucine, lysine, and methionine: three important essential amino acids [48:00];The vital role of ruminant animals in the production of quality protein [53:15];The differing needs and impacts of dietary protein for a 16-year old compared to a 65-year old [59:30];Consequences of protein deficiency in childhood [1:06:30];Muscle protein synthesis: ideal timing, small meals vs. big meals, and more [1:12:45];Protein needs of children [1:19:45];How important is timing protein intake around training? [1:24:15];The role of leucine in fatty acid oxidation by muscle [1:28:15];High protein diets for fat loss: Results from Don’s clinical trials [1:31:30];Influence of industry funding on nutrition studies [1:43:45];Don’s thoughts on plant-based and synthetic “meats” [1:48:45];Problems with epidemiological studies of dietary protein [1:56:30];More. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#223 - AMA #39: The Centenarian Decathlon, zone 2, VO2 max, and more
Sep 19 2022
#223 - AMA #39: The Centenarian Decathlon, zone 2, VO2 max, and more
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter describes what it means to exercise with the goal of longevity in mind, including his personal goals, exercise framework, and how he is optimizing for what he refers to as the “Centenarian Decathlon.” He explains the various types of cardiovascular training and how to partition your time between intensity levels (i.e., zone 2 training vs. zone 5 training) to optimize cardiorespiratory benefit. Additionally, Peter dives deep into questions around VO2 max, such as why it’s critical for longevity, how to improve it, and the value in starting VO2 max optimization early in life. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #39 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Exercise topics to be discussed [1:45];Peter’s exercise goals, and the Centenarian Decathlon [4:00];Peter’s exercise framework, and how he tracks his MET hours [8:30];How to partition your time between low and high intensity exercise to optimize results [13:15];Zone 2 exercise: ideal training methods and how to determine your zone 2 level [23:15];Rucking as a versatile mode of exercise [31:45];Zone 5 exercise: modalities of training, time per week, and other considerations [34:30];The importance of knowing your VO2 max, and methods for estimating it [38:15];Training methods for improving VO2 max, and realistic targets for improvement [46:00];Relationship of VO2max with age and the required fitness levels for daily life activities and exercise [52:30];The training necessary to maintain an elite VO2 max throughout life [58:45];The value in starting early: the compounding nature of fitness [1:01:45]; andMore. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#222 ‒ How nutrition impacts longevity | Matt Kaeberlein, Ph.D
Sep 12 2022
#222 ‒ How nutrition impacts longevity | Matt Kaeberlein, Ph.D
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Dr. Matt Kaeberlein is a globally recognized expert on the biology of aging and recurring on The Drive. In this episode, Matt explains his research findings on nutrition as it relates to aging and longevity, including the results from his recent review article in Science. From there, he and Peter dive deep into the literature on calorie restriction (CR), explaining the nuance, benefits for lifespan and healthspan, and potential downsides of CR. He discusses the epigenetic changes that occur with age and potential benefits and downsides of epigenetic reprogramming, often viewed as a panacea for reversing aging. Matt also explains the impact of dietary protein on aging, including the interesting dichotomy around how protein, a critical macronutrient, and rapamycin, a geroprotective molecule, have opposite effects on mTOR. Additionally, he talks about low-protein vs. high-protein diets and their effects on muscle mass and mortality, as well as the impact of IGF-1 signaling and growth hormone on lifespan. We discuss: Challenges with understanding the effects of nutrition and studying interventions for aging [3:30];How Peter’s and Matt’s convictions on nutrition and thoughts optimal health have evolved [8:15];Calorie restriction for improving lifespan in animal models [16:15];Utility of epigenetic clocks and possibility of epigenetic reprogramming [22:00];Mutations and changes to the epigenome with aging [31:45];Epigenetic reprogramming: potential benefits and downsides and whether it can work in every organ/tissue [35:15];First potential applications of anti-aging therapies and tips for aging well [43:00];Impact of calorie restriction on the immune system, muscle mass, and strength [47:00];Insights from famous calorie restriction studies in rhesus macaques [55:00];An evolutionary perspective of the human diet [1:03:45];Antiaging diets: Separating fact from fiction—Matt’s 2021 review in Science [1:12:30];Mouse models of time-restricted feeding in the context of calorie restriction [1:19:30];Nutritional interventions that consistently impact lifespan in mice, and concerns around efficacy in humans [1:27:00];Differing impact of calorie restriction when started later in life [1:31:00];Lifespan extension with rapamycin in older mice [1:37:15];Relationship between protein intake and aging, and mouse studies showing protein restriction can extend lifespan [1:43:30];Impact of protein intake on mTOR, and why inhibition of mTOR doesn’t cause muscle loss [1:50:45];Low-protein vs. high-protein diets and their effects on muscle mass, mortality, and more [1:55:30];The impact of IGF-1 signaling and growth hormone on lifespan [2:06:30];Parting thoughts on the contribution of nutrition to healthspan and lifespan [2:19:45];More. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#221 ‒ Understanding sleep and how to improve it
Sep 5 2022
#221 ‒ Understanding sleep and how to improve it
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this special episode of The Drive, we have pulled together a variety of clips from previous podcasts with sleep expert Dr. Matthew Walker to help listeners understand this topic more deeply, as well as to identify which previous episodes featuring Matt may be of interest. In this episode, Matt gives an overview of why we sleep, the stages of sleep, and sleep chronotypes, and he provides tips to those looking to improve their total sleep and sleep efficiency. Additionally, Matt discusses the pros and cons of napping, and gives his current thinking on the effects of blue light and caffeine on sleep. Finally, Matt explains the dangers of sleeping pills and reveals what he believes are the most useful alternatives for someone struggling with sleep, such as those with insomnia. We discuss: Evolutionary reasons to sleep [2:15];Stages of sleep, sleep cycles, and brainwaves [10:00];Understanding sleep chronotypes and how knowing yours could help you [25:45];Defining sleep efficiency and how to improve it [36:15];Correcting insomnia: a counterintuitive approach [38:45];Pros and cons of napping, and insights from the sleep habits of hunter-gatherer tribes [41:30];Sleep hygiene, wind-down routine, and tips for better sleep [50:15];The optimal room temperature and body temperature for the best sleep [59:30];Blue light: how Matt shifted his thinking [1:08:30];Caffeine: how Matt has adjusted his hypothesis [1:14:45];The dangers of sleeping pills, useful alternatives, and cognitive behavioral therapy for insomnia [1:19:45];More. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#220 ‒ Ketamine: Benefits, risks, and promising therapeutic potential | Celia Morgan, Ph.D.
Aug 29 2022
#220 ‒ Ketamine: Benefits, risks, and promising therapeutic potential | Celia Morgan, Ph.D.
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Celia Morgan is a Professor of Psychopharmacology at the University of Exeter who has authored numerous publications on the potential therapeutic uses of ketamine in mental healthcare. In this episode, Celia dives deep into the neurobiology of ketamine, how it affects users, and how it differs from other, more classical psychedelics (LSD, MDMA, PCP, and psilocybin). She explains the potential promise of ketamine as a treatment for recalcitrant depression and addiction, and she details the results from her clinical trials in these areas. She discusses the importance of using ketamine in combination with psychotherapy to maximize its benefits, the potential risks associated with ketamine use, and advice for those interested in the therapeutic use of ketamine. We discuss: Celia’s training and interest in ketamine [2:15];The history of ketamine, medical uses, and use as a party drug [3:30];Neurobiology and pharmacology of ketamine [8:15];Ketamine regulation and abuse, and how it compares with psychedelics and other molecules [18:15];Ketamine as a therapeutic for depression [30:45];The brain under the influence of ketamine and theoretical mechanisms for its anti-depressive effects [48:00];Risks and concerns with overusing ketamine, and what an intermittent or maintenance dose might look for a patient [57:15];Treating addiction with ketamine: Celia’s studies of alcohol dependance [1:04:00];Advice for people considering the therapeutic use of ketamine [1:19:45];More. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#219 ‒ Dialectical behavior therapy (DBT): skills for overcoming depression , emotional dysregulation, and more | Shireen Rizvi, Ph.D., ABPP
Aug 22 2022
#219 ‒ Dialectical behavior therapy (DBT): skills for overcoming depression , emotional dysregulation, and more | Shireen Rizvi, Ph.D., ABPP
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Shireen Rizvi is a Professor of Clinical Psychology and Psychiatry at Rutgers University, where she is also the Director of the Dialectical Behavior Therapy Clinic. This episode focuses specifically on dialectical behavior therapy (DBT), a skills-based technique which was originally developed to treat borderline personality disorder (BPD) and has since been adapted to treat depression and other mental health conditions, as well as to help people who have difficulty with emotional regulation and self-destructive behaviors. Shireen explains the origins of DBT and how its creator, Dr. Marsha Linehan, came to find a need for something beyond cognitive behavioral therapy (CBT) when attempting to treat patients with suicidal behavior. From there, Shireen dives into how DBT works to resolve the apparent contradiction between self-acceptance and change to bring about positive changes in emotional regulation, interpersonal effectiveness, mindfulness, distress tolerance, and more. She also provides examples for how one can apply specific skills taught with DBT such as accessing the “wise mind,” applying radical acceptance, using the “DEAR MAN” technique, and utilizing an emotion regulation skill called “opposite action.” Finally, she explains how the tenets of DBT offer benefits to anyone, and she provides insights and resources for people wanting to further explore DBT. We discuss: The basics of dialectical behavior therapy (DBT) and how it differs from cognitive behavioral therapy (CBT) [3:00];Treating depression with CBT: history, effectiveness, and how it laid the groundwork for DBT [8:15];Marsha Linehan’s inspiration for developing DBT [16:00];Explaining borderline personality disorder (and associated conditions) through the lens of DBT [20:00];How work with suicidal patients led to the development of DBT—a dialectic between change and acceptance [35:30];Details of DBT: defining the term “dialectical” and how to access the “wise mind” [44:30];Practicing mindfulness and radical acceptance in the context of DBT [51:00];Applying “radical acceptance” to tragic scenarios [1:02:00];The five domains of skills taught in DBT [1:07:15];Why Marsha chose borderline personality disorder as her focus when developing DBT [1:13:30];Is there any benefit in doing DBT for someone without a pathological condition? [1:15:45];The DEAR MAN skill of DBT [1:20:00];Adapting DBT skills for adolescents and families [1:31:00];Identifying vulnerability factors, increasing distress tolerance, and the impact of physical pain [1:33:45];The DBT chain analysis: assessing problem behaviors and identifying vulnerability factors [1:44:30];Why the regulation of emotions can be so challenging [1:50:30];The importance of mindfulness skills in DBT [1:53:30];Opposite action: an emotion regulation skill [1:57:00];Advice for those wanting to explore DBT [2:03:15];Finding a well-trained DBT therapist [2:08:15];More. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#218 - AMA #38: Can you exercise too much?
Aug 15 2022
#218 - AMA #38: Can you exercise too much?
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter dives deep into the question of whether there is such a thing as “too much exercise.” He explores the theoretical “J-curve” relationship between exercise and longevity, whereby mortality risk declines with increasing activity levels only to see an uptick above a certain exercise volume threshold. While Peter maintains that exercise is perhaps the single most important tool we have to live longer and live better, he explains the challenges involved in identifying an optimal dose. He takes a hard look at studies—many of which have contradictory results—to highlight major limitations in methodology and how readers could be misled. Additionally, he discusses the rare, but real, risks associated with extreme levels of physical activity and concludes by weighing the benefits against the risks of exercise. 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 #38 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: How exercise reduces risk for all-cause mortality [2:40];Defining the metric called “MET” and how it’s useful for evaluating different exercises [8:00];The challenge in determining the optimal exercise doses and the limitations of methods used to study the effect of exercise [13:45];  Using VO2 max as a proxy for fitness to better predict mortality risk [19:30];Reviewing data which support the theory of a “J-curve” relationship between exercise and longevity [25:00];Importance of understanding p-values and statistical significance [33:45];Deconstructing the studies that show a J-curve: major limitations and how one could be misled [37:00];Peter’s takeaways on the theoretical “J-curve” relationship between exercise and longevity [51:30];Risk of sudden cardiac death from vigorous physical exertion [54:00];Atrial fibrillation associated with extreme levels of exercise [1:00:15];Parting thoughts: benefits of exercise far outweigh the risks [1:04:15]; andMore. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#217 ‒ Exercise, VO2 max, and longevity | Mike Joyner, M.D.
Aug 8 2022
#217 ‒ Exercise, VO2 max, and longevity | Mike Joyner, M.D.
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Mike Joyner is a physician-researcher and one of the world’s leading experts on human performance and exercise physiology. In this episode, Mike discusses how to combat age-related declines in health and fitness levels by using various modes of exercise to improve lifespan and healthspan. Mike explains the impact of exercise on the autonomic nervous system, blood pressure, heart rate, heart rate variability, heart rate recovery, and max heart rate. He dives deep into VO2 max, including how it’s measured, what is driving it, and how to improve it. Mike provides training insights for the average person, including training volume and exercise intensity as well as simple metrics to track. Furthermore, he gives his take on the theoretical “J-curve” relationship between exercise and longevity, as well as whether possible health dangers may be associated with excessive exercise. We discuss: Mike’s training as an anesthesiologist and interest in exercise physiology [2:30];How exercise increases longevity [7:00];The impressive data on the benefits of exercise [9:45];The Centenarian Olympics and other ways to mitigate age-related decline in strength and stability [15:00];The violent dropoff in strength and activity with age and how exercise preserves fitness in old age [19:00];Benefits of exercise on mortality and fracture risk, and the interplay of nutrition and exercise [22:00];How exercise benefits the autonomic nervous system and why this plays an important role in our health [26:30];VO2 max, heart rate recovery, heart rate variability, and other metrics of fitness positively impacted by exercise [28:30];Reduction in all-cause mortality with increased fitness levels and VO2 max [32:45];Does the relationship between exercise and longevity follow a J-curve? [40:00];Mitigating age-related decline in fitness by elevating your VO2 max at a young age [46:15];Breaking down the variables that drive VO2 max [54:30];Learning from elite athletes: Training regimens, aerobic efficiency, and other impressive metrics [1:00:15];Health benefits of light exercise for the average person [1:09:00];Simple training metrics to track, and Mike’s current exercise regimen [1:11:15];How to boost your VO2 max, and the importance of form and tempo with interval training [1:18:15];Training advice for the average person [1:25:15];Why professional athletes have longer careers than they’ve had in the past [1:27:30];Use of performance-enhancing drugs in professional sports [1:29:45];Can the miracle of exercise be put in a pill? [1:36:00];Mike’s current research and questions he’s most interested in answering [1:39:00];Use of convalescent plasma to treat COVID-19 [1:41:15];Parting thoughts on the current state of fitness and exercise in society [1:47:15];More. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#216 - Metabolomics, NAD+, and cancer metabolism | Josh Rabinowitz, M.D., Ph.D.
Aug 1 2022
#216 - Metabolomics, NAD+, and cancer metabolism | Josh Rabinowitz, M.D., Ph.D.
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Josh Rabinowitz is a Professor of Chemistry and Integrative Genomics at Princeton University, where his research focuses on developing a quantitative, comprehensive understanding of cellular metabolism through the study of metabolites and their fluxes. In this episode, Josh focuses the discussion on three main topics: metabolomics, NAD (and its precursors), and cancer metabolism. The metabolomics discussion starts with a broad definition of metabolism, metabolites, and fluxomics before diving deep into glucose metabolism, lactate as a fuel, movement of lactate, and the regulation of these substrates. He then gives a detailed explanation of the electron transport chain and Krebs cycle and their implications with respect to both drugs and nutrition while also explaining how NAD is central to the process of energy generation. He then discusses the age-related decline in NAD and what current literature says about efforts to increase NAD through intravenous or oral supplementation with the precursors NMN and NR, including whether doing so provides any advantage to lifespan or healthspan. Finally, Josh ends the conversation talking about cancer metabolism and how one particular intersection between cancer metabolism and immunotherapy might provide a hopeful outlook on the future of cancer treatment. We discuss: Josh’s background and unique path to becoming a research scientist at Princeton [3:30];What sparked Josh’s early interest in metabolism [11:15];Metabolomics 101: defining metabolites and how they are regulated [16:30];Fluxomics: metabolism as a system in action [26:00];The Randle Hypothesis: glucose and fatty acids compete as substrates for oxidation [33:30];The important role of lactate as an alternate fuel [36:30];Fasting lactate levels as a potential early indicator of metabolic dysfunction [48:00];The beauty of the Krebs cycle and the role of NAD in energy production [53:15];How the drug metformin acts on complex I of the electron transport chain [1:05:00];The difference between NADH and NADPH [1:08:45];NAD levels with age, and the efficacy of supplementing with intravenous NAD [1:10:45];The usefulness of restoring NAD levels and efficacy of oral supplementation with NAD precursors NR and NMN [1:22:15];Exploring the hypothesis that boosting NAD levels is beneficial [1:32:30];Cancer metabolism and the intersection with immunotherapy [1:39:00];Making cancer a chronic disease: exploiting the metabolic quirks of cancer, augmenting the immune system, and more [1:46:15];The challenge of treating pancreatic cancer [1:50:30];Epithelial cancers that might respond to metabolic approaches to therapy [1:56:30];Josh’s hopeful outlook on the future of cancer treatment [1:59:00];Nutritional approaches to cancer attenuation [2:00:15];What makes Princeton University special [2:06:15];More. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#215 - The gut-brain connection | Michael Gershon, M.D.
Jul 25 2022
#215 - The gut-brain connection | Michael Gershon, M.D.
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Mike Gershon is a Professor of Pathology and Cell Biology at Columbia University and has been at the forefront of studying neural control of the gut for the past 60 years. In this episode, Mike gives a tour de force on the pathways of gut-brain communication but first sets the stage with an overview of gastrointestinal tract development and anatomy. He then explains how the gut communicates with the brain and vice versa, from early observations in physiology and anatomy up to our present understanding of what makes the GI tract so unique and complex relative to other organs. He talks about how the gut responds to meals of different food qualities and how that affects satiety signaling to the brain. Additionally, he explains how antidepressants and other drugs impact digestion through effects on serotonin signaling, and he discusses the effects of antibiotics, and what’s really going on with “leaky gut.” Finally, Mike offers his thoughts on the utility—or lack thereof—of gut microbiome diagnostic tests, and wraps up the discussion by considering how diet, probiotics, and prebiotics impact the microbiome and GI tract. We discuss: The basics of the gastrointestinal (GI) system [3:45];The very early development of the GI system [9:30];The unique properties of the blood supply and portal system in the GI tract [12:45];An overview of gut anatomy and innervation [16:30];Turnover of the epithelial lining and why cancer rarely develops in the small intestine [26:45];Nutrient and water absorption in the small and large intestine [30:30];Ways in which the gut and brain communicate [34:30];The gut's role in the regulation of appetite [43:30];The impact of gastric bypass surgery on satiety signals [51:15];How varicella-zoster virus (VZV) can infect neurons in the gut and create issues later in life [54:30];The relationship between autism and gastrointestinal illness [1:02:45];The important role of serotonin in the gut, and the impact of SSRIs on serotonin in the gut [1:09:45];Defining “leaky gut” and its most common causes [1:16:45];The gut microbiome [1:30:45];Fecal transplants: use cases, limitations, and how they illustrate the importance of gut microbes [1:40:45];Gut microbiome diagnostic tests: why they aren’t useful outside of special cases such as cancer detection [1:50:30];Nutritional approaches to a maintain optimal flora in the gut [1:55:00];Prebiotics and probiotics, and getting your GI system back on track after a course of antibiotics [2:02:30];More. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#214 - AMA #37: Bone health—everything you need to know
Jul 18 2022
#214 - AMA #37: Bone health—everything you need to know
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of bone health and explains why this is an important topic for everyone, from children to the elderly. He begins with an overview of bone mineral density, how it's measured, how it changes over the course of life, and the variability between sexes largely due to changes in estrogen levels. From there he provides insights into ways that one can improve bone health, from exercise to nutrition supplements to drugs. Additionally, Peter discusses what happens when one may be forced to be sedentary (e.g., bedrest) and how you can work to minimize the damage during these periods. 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 #37 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Overview of bone health topics to be discussed [1:45];Bones 101: bone function, structure, and more [5:15];Bone mineral density (BMD), minerals in bone, role of osteoblasts and osteoclasts, and more [8:30];The consequences of poor bone health [13:30];The devastating nature of hip fractures: morbidity and mortality data [17:00];Where fractures tend to occur in the body [23:00];Defining osteopenia and osteoporosis [24:30];Measuring BMD with DEXA and how to interpret scores [27:00];Variability in BMD between sexes [34:15];When should people have their first bone mineral density scan? [36:45];How BMD changes throughout the life and how it differs between men and women [39:00];How changes in estrogen levels (e.g., menopause) impact bone health [44:00];Why HRT is not considered a standard of care for postmenopausal bone loss [47:30];Factors determining who may be at higher risk of poor bone health [50:30];Common drugs that can negatively impact BMD [54:15];How children can optimize bone health and lay the foundation for the future [57:45];Types of physical activity that can positively impact bone health [1:02:30];How weight loss can negatively impact bone health and how exercise can counteract those effects [1:10:45];Nutrition and supplements for bone health [1:14:15];Pharmaceutical drugs prescribed for those with low BMD [1:17:15];Impact of extreme sedentary periods (e.g., bedrest) and how to minimize their damage to bone [1:22:00]; andMore. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#213 ‒ Liquid biopsies and cancer detection | Max Diehn, M.D. Ph.D.
Jul 11 2022
#213 ‒ Liquid biopsies and cancer detection | Max Diehn, M.D. Ph.D.
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Max Diehn is a Professor of Radiation Oncology at Stanford and a clinical radiation oncologist specializing in lung cancer. Max’s research focuses on developing novel methods for detecting circulating tumor DNA in the blood of cancer patients and on elucidating the molecular pathways and genes associated with cancer. His interests also include uncovering biomarkers that can predict patient survival, responses to therapy, and disease recurrence. In this packed episode, Max discusses the history of blood-based cancer screening and the importance of understanding the predictive value of tests—sensitivity, specificity, negative predictive value, positive predictive value – and how these metrics play into cancer screening. Max then goes in depth on the topic of liquid biopsies, including the history, current landscape, and possible future of liquid biopsies as a cancer detection tool. He discusses how these non-invasive blood tests can detect DNA/RNA from tumor cells released into the blood as well as the different methods one can use to predict if a cancer is present. He gets granular on the topic of cell-free DNA/RNA signature, methylation patterns, and the importance of knowing mutation information, and he ends with a discussion on the exciting future of liquid biopsies and how we can possibly get to the panacea of cancer screening. We discuss: Max’s training that planted the seeds for development of liquid biopsies [4:30];Max’s decision to specialize in radiation oncology [11:45];A culture at Stanford that values research and physician scientists [17:00];The motivation to develop liquid biopsies [19:15];History of blood-based cancer screening and understanding the predictive value of tests [25:30];Current state of lung cancer and the need for better screening [32:45];Low-dose CT scans: an important tool for managing lung cancer but with limitations [42:00];Using liquid biopsies to identify circulating tumor cells [47:00];Liquid biopsy research moves from circulating tumor cells to cell-free DNA [1:03:00];Zeroing-in on circulating tumor DNA in cell-free DNA [1:10:48];Cell-free RNA and Max’s vision for cancer detection from a blood sample [1:22:00];Methylation patterns and other informative signatures found in DNA [1:24:30];Mutation-based methods of liquid biopsies [1:26:30];Understanding the sensitivity and specificity of a diagnostic test [1:30:30];Existing clinical liquid biopsy tests and their limitations [1:37:30];The future of liquid biopsies [1:44:00];How we get to the panacea of cancer screening [1:52:00];More. Connect With Peter on Twitter, Instagram, Facebook and YouTube
Earning the gift of life | Ric Elias (#79 rebroadcast)
Jul 4 2022
Earning the gift of life | Ric Elias (#79 rebroadcast)
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this episode, Ric Elias, founder of Red Ventures, opens up about the fateful day he knew for certain that he was going to die as a passenger on US Airways Flight 1549. Ric dives deep into how that day impacted his life, greatly changed his perspective, and improved his relationship with his family and the broader community. We also talk about his incredible role as CEO of an enormous company, his remarkable work in philanthropy, and all the wisdom he has acquired in his extraordinary life. We discuss:  Ric’s life leading up to the day of the plane crash [2:15];The plane crash—What it’s like knowing you’re about to die, feelings of regret and sadness [8:00];The improbable plane landing in the Hudson River [15:45];Emotions after the safe landing (and a story he’s never told before) [22:15];A powerful story about Captain Sully [26:15];Earning his second chance at life, and playing the “infinite game” [35:15];Why time is the ultimate currency, and how (and why) to say “no” [43:00];Raising kids in an achievement culture, Ric’s definition of life success, and what Ric wants to instill in his kids [49:45];What Ric believes is actually worth getting upset about, and the organizations that are taking steps to help people [1:05:45];The core principles of Red Ventures (Ric’s company) [1:16:00];Ric’s tips for developing business acumen and negotiation skills [1:26:15];What qualities does Ric look for in people he wants to work with? [1:29:15];What is the next big problem that Ric wants to solve? [1:32:15];What is the most challenging part of your business today? [1:34:15];If Ric could go back and talk to himself in the morning before getting on that plane, what would he say? [1:36:00]; andMore. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#212 - The neuroscience of obesity | Stephan Guyenet, Ph.D.
Jun 27 2022
#212 - The neuroscience of obesity | Stephan Guyenet, Ph.D.
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Stephan Guyenet is a neuroscientist focused on the neuroscience of obesity and energy homeostasis.  He is the author of the book, The Hungry Brain and founder/director of Red Pen Reviews. In this episode, Stephan explains how obesity has changed phenotypically over the course of human history as well as what might explain the dramatic increase in prevalence of obesity in the last few decades. He talks in depth about the role of genetics, the brain, and hormones like leptin play in the regulation of fat mass. He dives deep into two common theories of obesity—the carbohydrate-insulin model and the energy balance model and provides his take on which theory has stronger evidence. Additionally, he provides insights on how we’re hard-wired to think about food and the consequences of modern foods designed for maximal pleasure. Finally, he goes through the factors that affect body weight, set points, and provides takeaways for people wanting to take advantage of what we know about the brain’s role in regulating our body weight. We discuss: Stephan’s neuroscience background and his focus on the nuances of obesity [2:15];How obesity has changed for humans throughout history [8:00];The association between obesity and adverse health outcomes, the “obesity paradox,” and confounders when relating BMI to longevity [14:00];The sharp increase in obesity across demographics [23:30];The hypothalamus and its role in obesity [30:00]; The role of the hormone leptin in obesity [40:00];The genetic component of obesity [46:30];Understanding the tendency of humans to store fat through an evolutionary lens [57:00];  The hedonic aspect of food, and how the brain reacts to modern, highly-rewarding foods [1:03:30];How we are hard-wired to think about food [1:14:30];A review of the “Carnivore diet” [1:21:45];The energy balance model, carbohydrate-insulin model, and unifying the theories around adiposity [1:34:15];Body weight set points: a hypothetical comparison of two individuals [1:41:45];Takeaways for people who want to lose weight and keep it off [1:48:30];Evidence that favors the energy balance model of weight gain [1:56:00];The synergistic effect of fat and carbohydrates and observations that a low-fat diet or a low-carb diet can cause weight loss [2:04:30];Red Pen Reviews [2:11:00];More. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#211 - AMA #36: Fruits & vegetables—everything you need to know
Jun 20 2022
#211 - AMA #36: Fruits & vegetables—everything you need to know
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter discusses the nutritional profiles of various fruits and vegetables as a means of assessing their relative value. He explains the difference between eating them vs. drinking them, how processing fruits and vegetables can change their properties, and how one’s current state of health affects nutrition strategy when it comes to fruits and vegetable consumption. Additionally, Peter explains the potential benefits and negative effects of certain phytochemicals found in produce and concludes with a discussion of supplementing with green powders, multivitamins, and more. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #36 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: The limitations of nutritional data and challenges of making broad recommendations [2:00];How one’s current state of health impacts their “optimal” diet [11:30];Defining “metabolic health” [14:45];The wide-ranging nutrition profiles of various fruits and vegetables [16:30];The benefits of fiber [20:45];Eating whole fruits vs. drinking fruit juice or smoothies [22:30];Drinking alcohol: metabolic effects, calories in alcohol, and more [28:30];Can excess fruit consumption lead to insulin resistance? [30:30];Glycemic impact of different fruits, using CGM data to assist decision making, and how fruit is fundamentally different from what we evolved to eat [31:30];Dietary approaches for people with a carbohydrate tolerance disorder (TD2, NAFLD, etc.), and when it makes sense to restrict fruit consumption [34:30];Nutrition profile of select vegetables: sugar content, micronutrients, and more [40:00];Phytochemicals in produce: potential positive health impacts on inflammation, cardiovascular (CV) risk, and cancer [44:30];Phytochemicals with potential negative health impacts [50:45];Nightshades and inflammation [53:15];How important is it to eat organic foods? [56:00];How necessary is it to wash fruits and vegetables? [1:00:45];How does food preparation change the nutritional composition? [1:03:45];Considerations when eating canned and frozen food, and paying attention to processed food additives [1:04:45];Supplementing vitamins and nutrients as an alternative to eating whole fruits and vegetables [1:06:15];Green powder supplements [1:11:15];Important takeaways [1:16:00]; andMore. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#210 - Lp(a) and its impact on heart disease | Benoît Arsenault, Ph.D.
Jun 13 2022
#210 - Lp(a) and its impact on heart disease | Benoît Arsenault, Ph.D.
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Benoît Arsenault is a research scientist focused on understanding how lifestyle and genetic factors contribute to cardiovascular disease risk. In this episode, the discussion casts a spotlight on Lp(a)—the single most important genetically-inherited trait when it comes to atherosclerotic cardiovascular disease (ASCVD) risk. Benoît explains the biology of Lp(a), how it’s inherited, the importance of measuring Lp(a) levels, and the diseases most associated with high Lp(a). He dives into data on the possible treatments for lowering Lp(a) such niacin, statins, and PCSK9 inhibitors, as well as the most exciting new potential therapeutic—antisense oligonucleotides. We discuss: How Benoît came to study Lp(a)—a new marker for cardiovascular risk [3:15];The relationship between Lp(a) and CVD risk [6:45];What genome-wide association studies (GWAS) revealed about Lp(a) [16:00];Clinical tests to measure Lp(a) [22:00];The biology of Lp(a) [25:45];How statins lower LDL-cholesterol and why this doesn't work for an Lp(a) [29:15];The structure of LDL-p and Lp(a) and what makes Lp(a) more atherogenic than an equivalent LDL particle [34:00];The role of Lp(a) in aortic valve disease [42:45];How greater numbers of Lp(a) particles are associated with increased risk of disease [48:00];The genetics and inheritance of Lp(a) and how and when to measure Lp(a) levels [52:00];Niacin and other proposed therapies to lower Lp(a), apoB, and CVD risk [1:00:45];Why awareness of Lp(a) among physicians remains low despite the importance of managing risk factors for ASCVD [1:14:00];The variability of disease in patients with high Lp(a) [1:19:00];Diseases most associated with high Lp(a) [1:26:30];The biology of PCSK9 protein, familial hypercholesterolemia, and the case for inhibiting PCSK9 [1:35:00];The variability in PCSK9 inhibitors’ ability to lower Lp(a) and why we need more research on individuals with high levels of Lp(a) [1:50:30];Peter’s approach to managing patients with high Lp(a), and Benoît’s personal approach to managing his risk [1:54:45];Antisense oligonucleotides—a potential new therapeutic for Lp(a) [1:57:15]; andMore. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#209 ‒ Medical mistakes, patient safety, and the RaDonda Vaught case | Marty Makary, M.D., M.P.H.
Jun 6 2022
#209 ‒ Medical mistakes, patient safety, and the RaDonda Vaught case | Marty Makary, M.D., M.P.H.
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Marty Makary is a surgeon, public policy researcher, and author of the New York times best-sellers Unaccountable and The Price We Pay. In this episode, Marty dives deep into the topic of patient safety. He describes the risk of medical errors that patients face when they walk into the hospital and how those errors take place, and he highlights what amounts to an epidemic of medical mistakes. He explains how the culture of patient safety has advanced in recent decades, the specific improvements driven by a patient safety movement, and what’s holding back further progress. The second half of this episode discusses the high-profile case of RaDonda Vaught, a nurse at Vanderbilt Hospital convicted of negligent homicide after she mistakenly gave a patient the wrong medication in 2017. He discusses the fallout from this case and how it has in some ways unraveled decades of progress in patient safety. Furthermore, Marty provides insights in how to advocate for a loved one in the hospital, details the changes needed to meaningfully reduce the death rate from medical errors, and provides a hopeful vision for future improvements to patient safety. We discuss: Brief history of patient safety, preventable medical mistakes, and catalysts for major changes to patient safety protocols [0:12];Advancements in patient safety and the dramatic reduction in central line infections [14:55];A surgical safety checklist—a major milestone in patient safety [23:03];A tragic case stimulates a culture of speaking up about concerns among surgical teams [25:19];Studies showing the ubiquitous nature of medical mistakes leading to patient death [29:42];The medical mistake of over-prescribing of opioids [33:48];Other types of errors—electronic medical records, nosocomial infections, and more [35:43];Importance of honesty from physicians and what really drives malpractice claims [40:26];A high-profile medical mistake case involving nurse RaDonda Vaught [47:31];Investigations leading to the arrest of RaDonda Vaught [59:48];Vaught’s trial—a charge of “negligent homicide” [1:05:16];A guilty charge and an outpouring of support for Vaught [1:12:09];Concerns from the nursing profession over the RaDonda Vaught conviction [1:18:09];How to advocate for a friend or family member in the hospital [1:20:22];Changes needed for meaningful reduction in the death rate from medical errors [1:26:42];Blind spots in our current national funding mechanism and the need for more research into patient safety [1:31:42];Parting thoughts—where do we go from here? [1:35:48];More. Connect With Peter on Twitter, Instagram, Facebook and YouTube
The Art of Stability | Beth Lewis (Ep. #131 Rebroadcast)
May 30 2022
The Art of Stability | Beth Lewis (Ep. #131 Rebroadcast)
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Beth Lewis is a former professional dancer and a self-described “educator of movement” who has an unmatched ability to assimilate information and customize training plans from multiple training systems. In this episode, Beth describes how she identifies problematic movement patterns and postures to help individuals relieve pain, avoid injury, and move better within all types of exercise. She explains how movement is a trainable skill and provides suggestions for ways that people can modify or supplement their exercise routine to benefit their health and longevity. We discuss: Beth’s “way of no way” training philosophy [2:15]Beth’s background in dancing and how she ended up in New York City [5:00]Beth’s transition to fitness coaching and how her training philosophy has evolved [10:15];Functional Range Conditioning and scapular mobility [19:20];An overview of the Postural Restoration Institute, and Peter’s squat assessment [33:00];The important connection between the ribs and breathing [37:15];The role of sitting and external stress in chronic muscular tension [40:00];The important role of your toes, minimalist footwear, and toe yoga [42:00];Dynamic Neuromuscular Stabilization (DNS) [46:00];A different view on knee valgus [50:15];Is there such a thing as “bad posture”? [54:00];How Beth identifies an issue, addresses it, and keeps clients motivated [56:15];Lifting weights, the Centenarian Olympics, and dancing into old age [1:08:30];The importance of the hamstrings versus abs [1:18:45];Benefits of rowing, and why everyone should add it to their exercise regimen [1:24:45]Different roles of concentric versus eccentric strength [1:32:45];Flexibility and high-intensity interval training (HIIT) [1:37:10];Training versus playing sports, and the best type of activity for kids [1:40:30]; andMore. Connect With Peter on Twitter, Instagram, Facebook and YouTube
#208 - Tragedy, grief, healing, and finding happiness | Kelsey Chittick
May 23 2022
#208 - Tragedy, grief, healing, and finding happiness | Kelsey Chittick
View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Kelsey Chittick is the author of Second Half: Surviving Loss and Finding Magic in the Missing. In this episode, Kelsey describes her long healing process following the sudden death of her husband, former NFL player Nate Hobgood-Chittick. She describes her life with Nate before and after football, including her premonitions that something was off about Nate and the subsequent finding that he suffered from chronic traumatic encephalopathy (CTE). She speaks openly about how she handled his death with her children, the trauma and grief they faced in the aftermath, and how she’s found ways to be happy in her new life. She shares deep insights into her healing process, including her experience with psychedelics and how the concept of “radical acceptance” has helped her to find joy once again. We discuss: Kelsey’s childhood in Florida as an athlete [2:15];Meeting Nate and early relationship with him [7:45];Nate’s unbelievable work ethic and desire to play in the NFL [12:30];Life with a professional football player, playing through pain, and head injuries related to football [17:00];Nate’s final days of football and early retirement struggles [23:30];The tough transition from the NFL to a “regular life” and how Nate found a way to serve others [28:45];Nate’s struggle with his weight and overall health after retirement [34:45];Kelsey’s anxiety and premonitions of Nate’s impending death, and Nate’s changing demeanor [37:30];The traumatic experience of learning of Nate’s death during her own spiritual journey to Jamaica [45:30];Breaking the news to her children of their father’s death [51:00];The darkest days following Nate’s passing and how her children were handling grief [55:30];A new relationship with death, finding happiness, and the duality of feelings [1:02:45];Nate’s autopsy results showing evidence of CTE [1:07:00];The grieving process [1:15:00];Dealing with grief with kids and how children grieve differently [1:19:15];Healing through her first psychedelic experience [1:23:00];The therapeutic potential of psychedelics, meditation, and more [1:33:45];The concept of “radical acceptance” and the peace that comes with it [1:42:30];The up and down experience of writing her book [1:47:45];More. Connect With Peter on Twitter, Instagram, Facebook and YouTube