The Peter Attia Drive

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

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

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

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

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Renowned social psychologists Carol Tavris and Elliot Aronson are the co-authors of Mistakes Were Made (But Not By Me), a book which explores the science of cognitive biases and discusses how the human brain is wired for self-justification. In this episode, Carol and Elliot discuss how our desire to reconcile mental conflicts adversely affects many aspects of society. The two give real-world examples to demonstrate the pitfalls in attempts to reduce mental conflict, or dissonance. The examples reveal that no one is immune to dissonance reduction behavior, how intellectual honesty can be trained and lastly, how to think critically in order to avoid engaging in harmful dissonant behaviors. We discuss: Carol and Elliot's respective background, collaboration history, and their decision to write Mistakes Were Made (But Not By Me) [4:00]; The theory of cognitive dissonance, and real examples of dissonance reduction in action [11:15]; How Elliot advanced the theory of cognitive dissonance [23:00]; The evolutionary reason for dissonance reduction, and cultural differences in what causes cognitive dissonance [30:30]; The great danger of smart, powerful people engaging in dissonance reduction [35:15]; Two case studies of cognitive dissonance in criminal justice [39:30]; The McMartin preschool case study—The danger in making judgements before knowing all the information [43:30]; How ideology distorts science and public opinion [56:30]; How time distorts memories [58:30]; The downside of certainty [1:05:30]; Are we all doomed to cognitive dissonance?—How two people with similar beliefs can diverge [1:09:00]; Cognitive dissonance in the police force [1:21:00]; A toolkit for overcoming cognitive dissonance [1:27:30]; Importance of separating identity from beliefs, thinking critically, & and the difficulty posed by political polarity [1:30:30]; How to impart the lessons from their work into future generations [1:48:00]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/caroltavris-elliotaronson/ 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.

World-renowned lipidologist Tom Dayspring returns to give an update on the current thinking in lipidology as a follow-up to his 2018 five-part podcast series. In this episode, Tom discusses the growing consensus that atherogenic lipoproteins are essential drivers of atherosclerotic vascular disease. Tom further emphasizes apolipoprotein B (apoB) and lipoprotein(a) (Lp(a)). He provides insights into risk assessment, including which lab metrics to use, how to interpret them, and the appropriate therapeutic targets. Additionally, Tom discusses the most recent developments in lipid-lowering drug therapies—from the continued evolution of PCSK9 inhibitors, to the latest understanding of EPA and DHA, and the most recent addition of bempedoic acid to the list of therapeutic agents. We discuss: The latest in the field of lipidology and cardiovascular disease [3:45]; Apolipoproteins—the key to understanding lipid biology [9:30]; ApoB as a preferred metric over LDL-P [16:30]; Therapeutic goals for apoB concentration [21:45]; Drivers of atherosclerosis [34:15]; Overview and current thinking on high density lipoproteins (HDLs)—Is it a useful metric? [37:00]; Lipoprotein(a)—the most dangerous particle you've never heard of [55:00]; Are low density lipoprotein triglycerides (LDL-TGs) a useful metric? [1:13:15]; Tom's preferred lab measurements [1:17:45]; The latest in lipid-lowering therapies [1:21:30]; The different pathways among various lipid-lowering drugs [1:30:45]; The latest on EPA and DHA [1:38:15]; Fibrates—an underappreciated treatment for hypercholesterolemia [1:49:45] and; More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/tomdayspring6 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.

Irene Davis is the founding Director of the Spaulding National Running Center at the Harvard Medical School. In this episode, Irene describes how her research of biomechanics and clinical work with running injuries, as well as research by others, has shaped her views on maintaining body alignment and foot health. Irene discusses her argument for the role of modern footwear in running-related injuries and how minimalist footwear helps resolve the subsequent biomechanical issues. We discuss: Irene's path to her Ph.D., her entry into physical therapy, and her interest in biomechanics [3:20]; How Irene's thinking about the use of orthotics has changed [7:15]; The evolution of the human foot and the transition from walking to running [10:30]; The evolution of shoes and its impact on running injuries [17:30]; An overview of running injuries [26:00]; Cushioned running shoes, heel striking and impact forces [29:30]; Shin splints [33:45]; How heel strike patterns promotes knee stress through rate of loading [35:30]; The critical importance of exercise [42:15]; Impact forces and injury potential [45:45]; How shoe cushioning alters impact forces despite forefoot striking [49:00]; An overview of minimalist shoes [52:30]; Irene's protocol for transitioning people out of orthotics [58:45]; Transitioning to minimalist shoes and a forefoot strike [1:05:30]; Foot muscle volume, minimalist shoes, and orthotics [1:07:00]; The recognition of the importance of foot strength in podiatry [1:09:45]; Minimalist shoes across the lifespan—from children to adults [1:12:30]; Why learning to forefoot strike on soft surfaces is not the best approach [1:20:00]; Knee valgus and factors related to knee injury [1:21:45]; IT band syndrome [1:28:30]; Physics and ground reaction forces [1:33:15]; Irene's approach to retraining a runner's gait [1:36:00]; Case study—How the transition to minimalist shoes decreased injury and improved performance [1:42:15]; Importance of proper movement patterns and the negative influence of our modern environment [1:45:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/irenedavis 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.

In this special episode, Matthew Walker returns for his third AMA episode to provide his expert insight into numerous sleep-related questions directly from listeners. He explains how he adjusted his hypotheses on topics like blue light and caffeine, and why he is more bullish on the importance of REM sleep. Matt also answers questions about sleep wearables, how fasting affects sleep, how sleep deprivation impacts gut health, and magnesium as a sleep aid. Finally, Matt reveals what he believes is the next evolution in sleep science and technology. If you're a subscriber, you can now listen to this full episode on your private RSS feed or on our website on the show notes page. We discuss: Matt's framework for changing his mind when faced with new information [1:30]; Blue light—How Matt shifted his thinking [5:45]; Caffeine—How Matt has adjusted his hypothesis [12:00]; REM sleep—Why Matt is more bullish on the importance of dream sleep [16:30]; How to increase REM sleep [27:30]; Sleep tracking wearables—criteria for evaluation, and why Matthew favors Oura [35:00]; Does the electromagnetic force of devices have any impact on sleep? [40:15]; The relationship between fasting and sleep [46:15]; Restless leg syndrome [58:10]; Magnesium supplementation as a sleep aid [1:03:00]; The relationship between sleep deprivation and gut health [1:08:30]; The next evolution in sleep science and technology [1:16:30]; Questions Matt would like to explore if money was no issue [1:24:15]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/matthewwalkerama3 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.

In this episode, sleep expert Matthew Walker returns by popular demand to dive deeper into many sleep-related topics, starting with what we've learned about sleep through the lens of the COVID-19 pandemic and how sleep impacts the immune system. He then covers topics such as how dreaming affects emotional health, the different sleep chronotypes, the best sleep hygiene tips, and the pros and cons of napping. Matthew finishes by addressing several of the errors that readers have pointed out in his book, Why We Sleep. We discuss: Three ways the coronavirus pandemic impacts sleep [3:30]; The importance of dreaming for emotional health, and how the coronavirus pandemic increases dreaming [11:45]; The impact of alcohol consumption on sleep quality and stress levels [20:00]; Sleep's impact on the immune system and implications for a future COVID-19 vaccine [27:45]; What determines how much deep sleep and REM sleep you need? [36:30]; Pros and cons of napping, and insights from the sleep habits of hunter-gatherer tribes [42:15]; Sleep hygiene, wind-down routine, and tips for better sleep [56:45]; Understanding sleep chronotypes and how knowing yours can help you [1:06:00]; Night terrors in kids—what they are and why they happen [1:16:30]; Addressing errors found in Matt's book, Why We Sleep [1:20:45]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/matthewwalker4 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.

John Arnold is widely regarded as the greatest natural gas trader of all time, but in his late 30's he walked away from it all and turned full-time philanthropist. He and his wife have committed to strategically give away most of their vast fortune in their lifetime and are already doing so at a staggering pace of nearly a half billion dollars a year. In this episode, John explains his quest to address the most challenging social programs plaguing the country, including criminal justice, health care policy, and K-12 education. John also shares self-identified attributes that contributed to his success in natural gas trading and how those same traits have translated to his philanthropic aspirations. We discuss: John's background, upbringing, and early entrepreneurial tendencies [3:50]; John's time and rise at Enron [16:45]; Characteristics that made John an exceptional natural gas trader and how they translate to his philanthropic work [27:30]; The collapse of Enron [35:00]; The success of John's hedge fund, and his early interest in philanthropy [40:30]; The infamous 2006 trade that brought down Amaranth Advisors [55:45]; John's analytical prowess and emphasis on fundamentals [1:02:15]; The decision to become a full-time philanthropist and the founding of Arnold Ventures [1:09:00]; Education—John's quest to fundamentally change K-12 education [1:18:45]; Strategic philanthropy—preventing problems by attacking root causes and creating structural change [1:24:30]; The criminal justice system—structural changes needed to address mass incarceration, policing practices, and recidivism [1:31:45]; Re-imagining prisons to reduce recidivism [1:49:00]; US health care policy—John's focus on drug prices, and the severe consequences of not making system changes [1:56:15]; Climate change—the bipartisan role of John's foundation [2:13:45]; Advice for young adults interested in philanthropy [2:17:45]; and More Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/JohnArnold 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.

As a follow up to AMA #14 where Peter explained his framework for analyzing labs, this "Ask Me Anything" (AMA) episode focuses on a number of real-world case studies exploring metabolic dysregulation, low testosterone, menopause, hypothyroidism, elevated uric acid, and more. From the examples discussed, you can follow along how our clinical team goes about interpreting diagnostic measures and applying relevant research findings. Once again, Bob Kaplan, Peter's head of research, will be asking the questions. If you're a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #15 show notes page. We discuss: Should you stop taking supplements before getting a lab test? [2:45]; Family history—Questions to ask and what to look for [5:30]; The purpose of an oral glucose tolerance test (OGTT) [12:15]; Case study—Insufficient muscle mass for proper glucose disposal [17:15]; Why hemoglobin A1c is a relatively unhelpful metric [24:00]; Case study—Exceeding carbohydrate tolerance [26:30]; Case study—Metabolic dysfunction and a framework for metabolic health [33:30]; Peter's ideal tracking of metabolic health for all his patients [43:30]; Contrasting presentations of hypogonadism—Low free testosterone [45:00]; How sleep, exercise, and alcohol affect testosterone levels? [56:20]; Case study—Surprisingly fast onset of menopause [59:25]; Case study—Hypothyroidism and high cholesterol [1:07:00]; Case study—Elevated uric acid and hypertension [1:10:55]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama15 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.

In this episode, Joan and Nir discuss their extensive research into rapamycin (including the category of analogs to rapamycin known as rapalogs) and metformin, respectively. Based on his work with metformin, Nir shares how he believes it could be a pro-longevity drug and the clinical trial he's leading to test this belief. Joan discusses her work with rapalogs, their ability to suppress the immune system as well as provide immune-enhancement, and the clinical trials she has led that inform her insights. We also talk about the potential beneficial roles of both metformin and rapamycin in reducing mortality from COVID-19, reducing the risk of neurodegenerative diseases, and delaying aging as well as its related diseases. We discuss: Joan's career, interest in aging, and work with rapamycin analogs [3:45]; When Nir became convinced metformin could be a pro-longevity agent [15:00]; How metformin and rapamycin impact the hallmarks of aging and extend lifespan [24:15]; Enhancing the immune system with rapalogs and metformin [34:15]; Potential of metformin and rapamycin in reducing mortality from COVID-19 [41:30]; Insights from Joan's studies investigating the immune-enhancing effects of rapalogs [59:30]; Vaccines and treatments strategies for COVID-19, and the likelihood of long-term immunity [1:08:15]; The potential role of rapalogs and metformin in neurodegenerative disease [1:14:30]; Nir's TAME trial—primary objectives and latest updates [1:18:00]; Potential synergistic effect when combining metformin with rapamycin [1:25:45]; Why Peter stopped taking metformin and started taking rapamycin [1:27:30]; Story from Nir's book that demonstrates the challenge of doing good scientific studies [1:37:30]; The biology of aging—epigenetic clocks, proteomics, and Nir's centenarian data [1:42:00]; Joan's dream experiment to test immune-enhancing effect of RTB101 [1:57:15]; Concluding thoughts on COVID-19 [1:59:45]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: http://peterattiamd.com/joanmannick-nirbarzilai/ 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.

Lori Gottlieb is a psychotherapist and the bestselling author of Maybe You Should Talk to Someone. In this episode, Lori extracts important lessons from her experiences as both a therapist and a patient. The stories Lori shares has provided her the material for insights into living a more fulfilling life. In our conversation, Lori also dispels some misconceptions about therapy, explains the process of big therapeutic breakthroughs, and reveals the most important steps for enduring emotional health. We discuss: Lori's unique path to becoming a therapist [3:00]; Dissecting cadavers—a profound experience during med school [12:30]; The sunk cost fallacy—How Lori was able to walk away from med school [17:15]; Being aware of the gift of life, and other lessons from Lori's terminally ill patient [24:00]; How underlying pain can manifest in obnoxious behavior [32:45]; Counseling versus therapy [36:15]; The story of John—why men hide their feelings, breaking down his shield, and uncovering his pain [38:30]; "Breaking open"—A shocking revelation about John that tests Lori's resolve as a therapist [46:30]; Rewriting your story, the recovery process, and the most important step for lasting change [49:00]; The process of many big therapeutic breakthroughs [56:00]; The 2 types of suicidal thoughts, and the importance of talking about it [1:01:00]; The most common issues that bring patients to therapy with Lori [1:02:45]; Clinging to the familiar—why change is so hard [1:05:15]; A story of shame, lack of self-compassion, and self-sabotage [1:07:00]; The importance of managing mental health to reduce unnecessary suffering [1:15:45]; Dispelling the misconceptions about therapy [1:23:15]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/LoriGottlieb 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.

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

In part 2 of this special AMA episode, ketosis expert Dom D'Agostino once again joins Bob Kaplan, Peter's Head of Research, to discuss the impact of ketosis on various chronic diseases as well as the latest research on the metabolic management of cancer. Dom also discusses the numerous applications of hyperbaric oxygen therapy, provides insights into the application of ketosis on female health and performance, and much more. If you're not a subscriber and listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or on the website show notes page. We discuss: Update on Dom's Press-pulse therapeutic strategy for the metabolic management of cancer [2:05]; Potential role for vitamin C in cancer treatment [12:45]; Glutamine targeting in cancer therapy—evidence that the mitochondria in cancer are damaged? [17:45]; Can a ketogenic diet lessen the toxicity of cancer therapies? [24:45]; 3BP—a promising agent in cancer therapy [26:45]; The relationship between cancer and ketogenic diets [29:30]; Hyperbaric oxygen therapy (HBOT)—primer, protocols, and therapeutic uses [33:30]; Is there a potential role for HBOT in treating COVID-19 patients? [44:15]; Non-cancer applications of HBOT [47:30]; The inverse relationship between glucose and ketones [50:30]; Is a ketogenic diet appropriate for type 1 diabetics? [54:00]; How ketosis may reduce the risk for Alzheimer's disease and Parkinson's disease [1:00:30]; Ketosis for females—considerations, fertility, performance, and the latest research [1:11:00]; Low-carb diets during pregnancy and postpartum [1:17:00]; A high-protein diet to counteract common hormonal issues associated with the ketogenic diet [1:21:15]; Nutritional tips for remaining metabolically flexible [1:22:45]; What is one belief Dom has changed his mind about? [1:26:45]; In utero experiments, and other interesting questions Dom wants to explore [1:29:45]; The anti-catabolic effect of ketones, cancer cachexia, and nutritional interventions for cancer patients [1:38:30]; What is the one interesting experiment Dom would do if money and time were not a barrier? [1:46:25]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/domdagostinoama02/ 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.

Terry Real, a renowned family therapist and best-selling author, helps people create the connections they desire in their relationships. In this episode, Terry describes how his upbringing with an abusive father forged his path to become a therapist, develop his Relational Life Therapy (RLT) framework, and write I Don't Want to Talk About It—a book that reveals the hidden legacy of male depression. Terry discusses the link between childhood trauma and the deep-rooted shame, anger, and depression, which can result in feeling disconnected. Using real-life examples, Terry explains how he implements RLT to confront trauma, discover its origin, and teach the skills to break the cycle of pain, in order to live a satisfying life. We discuss: Terry's upbringing with a depressed and abusive father [3:15]; The importance of the repair process, after relational disharmony, to break the trauma cycle [15:15]; The impact of a patriarchal society, and relational growth as the next step for feminism [19:00]; Origins of deep-rooted shame, and the difference between feeling ashamed and feeling guilty [27:15]; Preventing the propagation of trauma without over-coddling kids [35:30]; The one-up/one-down cycle from grandiosity to shame [37:30]; Covert depression—Steps to fixing the secret legacy of male depression [40:00]; Three forms of false self-esteem [50:00]; Narcissism—A misunderstood concept [51:45]; The interplay of shame, anger, and grandiosity, and how to break the cycle [54:15]; The Relational Life Therapy framework [1:06:30]; How the adaptive child becomes the maladaptive adult [1:15:30]; Speaking the language of social relationships [1:21:45]; When does it make sense for a couple to separate? [1:26:30]; Witness abuse—Consequences of screaming at your partner in the presence of children [1:28:15]; Cases of instantaneous change, and other behavioral changes that may take more time [1:30:45]; Reconciling with his father—Terry's final conversation with his dad [1:33:45]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/terryreal 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.

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

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

Back by very popular demand for a special AMA episode, ketosis expert Dom D'Agostino joins Bob Kaplan, Peter's Head of Research, to address many lingering questions about the ketogenic diet, exogenous ketones, and exercise for overall health. Dom also shares valuable insights from his personal experience with training, supplements, intermittent fasting, and other nutritional strategies to optimize his own health and performance. If you're not a subscriber and listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or on the website show notes page. We discuss: Dom's recent and ongoing projects [3:00]; Benefits of a ketogenic diet for an otherwise healthy person [7:00]; Book recommendations to become more knowledgeable about a ketogenic diet [11:30]; Best devices for measuring ketones [13:45]; Genetic factors that influence how someone responds to the ketogenic diet [24:45]; Ketogenic diet for those with the APOE e4 allele [28:15]; Impact of long-term ketogenic diets on thyroid function [34:25]; Low-carb and ketogenic diets for appetite control and weight management [39:00]; Ketogenic diet and the microbiome [43:00]; Comparing monounsaturated fat versus saturated fat on the ketogenic diet [45:55]; Implications of long-term genetic and epigenetic adaptations to a ketogenic diet [47:45]; Why some people see a rise in LDL-C and LDL-P when on a ketogenic diet and what they can do about it [50:15]; Should someone with familial hypercholesterolemia consider a ketogenic diet? [55:00]; Exogenous ketones—benefits, therapeutic uses, and ketone supplements that Dom has tested [56:45]; Ketogenic protocols for management of traumatic brain injuries [1:06:00]; Comparing the benefits and therapeutic uses of various medium-chain fatty acids—caprylic acid (C8), capric acid (C10), MCT oil, and coconut oil [1:08:45]; Nootropics, caffeine, and other stimulants [1:16:15]; Supplemental use of testosterone, DHEA, and creatine for muscle growth and performance [1:23:45]; Impact of fasted-state training on strength and performance [1:30:15]; Stacking exogenous ketones with MCTs for optimal effectiveness [1:33:30]; BCAA supplements during a fast for muscle preservation [1:35:45]; What app is Dom using to track his macros? [1:42:00]; Getting enough micronutrients while on a ketogenic diet [1:47:15]; Ideal macros and getting enough protein for strength training in ketosis [1:48:15]; Pros, cons, and ideal macros of one meal a day [1:51:15]; Dom's take on "carb backloading" [1:54:45]; Dom's take on "carb up" days for ketogenic dieters [2:01:00]; Dom's thoughts on the carnivore diet and the paleolithic ketogenic diet [2:05:30]; Advantages of the ketogenic diet for extreme endurance athletes [2:10:30]; Impact on strength, power, and performance during the adaptation period of the ketogenic diet [2:14:00]; Fasted-state elevation in growth hormone and its impact on training [2:17:45]; Is it possible to build muscle on a ketogenic diet? [2:23:30]; Why Dom took a year off from weight training [2:28:00]; What does Dom do for cardio exercise? [2:30:45]; Protocols for hard training recovery [2:33:15]; Dom's personal approach to fasting, time-restricted eating, and sleep [2:35:45]; People, books, and other resources that shaped Dom's training and nutrition [2:38:45]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/domdagostinoama01 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.

In this episode, David Watkins, professor of pathology at George Washington University, shares how insights from his HIV and Zika virus research could apply to SARS-CoV-2 protection strategies. David introduces monoclonal antibodies as an intervention to prevent and treat COVID-19 infection, and also discusses how they could be used as a hedge to vaccine development. Additionally, David's immunology tutorial explains the innate and adaptive immune systems and their differentiated responses to viral infection. We discuss: Background and current interest in immunology [4:30]; Immunology 101—The innate and adaptive immune system [10:15]; Defining antibodies, importance of neutralizing antibodies, and serology testing for COVID-19 [19:00]; B cells—How they fight viruses, create antibodies, and fit into the vaccine strategy [25:00]; T cells—Role in the adaptive immune system and ability to kill infected cells to prevent viral spread [36:15]; Valuable lessons from HIV applied to SARS-CoV-2 [51:00]; Lessons taken from the hepatitis C success story [1:01:30]; Monoclonal antibodies, vaccines, and the most promising strategies for preventing and treating COVID-19 infection [1:04:45]; COVID-19 vaccines in development [1:19:00]; How David's work with Zika virus informs his thinking on SARS-CoV-2 [1:25:20]; Why a vaccine for COVID-19 doesn't need to be perfect to be effective [1:27:45]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/davidwatkins 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.

In this episode, Eileen White, Chief Scientific Officer at the Rutgers Cancer Institute, describes the fundamental role of autophagy in the maintenance of health and prevention of neurodegeneration, cancer, and other diseases. She also goes into detail about the paradoxical finding that autophagy may benefit an existing cancer cell and help it to survive—a discovery leading to new possibilities in cancer therapy. We also discuss fasting (and molecules that induce autophagy) and the critical need to decode the proper fasting "dose" in order to improve human health. We discuss: Eileen's discovery that a specific oncogene blocks apoptosis [3:40]; Defining apoptosis and its role in cancer prevention [10:00]; How cancer cells use the autophagy pathway to survive [17:20]; Stressors that induce autophagy [29:15]; The importance of autophagy in the brain and liver [32:45]; The mechanisms that can trigger autophagy to support longevity [40:00]; Evidence for cancer treatment by blocking autophagy [42:30]; Types of cancer that are most autophagy-dependent [46:45]; The autophagy paradox [52:40]; Finding a molecular signal for autophagy [59:15]; Current knowledge gaps around fasting as a tool for longevity [1:13:00]; Rapamycin, metformin, and other molecules that may induce autophagy [1:22:15]; How to study fasting and exercise as longevity tools [1:32:50]; The Nobel Prize for autophagy research [1:36:45]; Eileen's future areas of research [1:38:25]; A fasting strategy for Alzheimer's Disease prevention[1:49:25]; Future study of metabolism and autophagy [1:51:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/eileenwhite 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.

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

Ned David is the co-founder of Unity Biotechnology, a company developing senolytic medicines—molecules that target and destroy senescent cells in the human body. In this episode, Ned explains the science of cellular senescence and how it impacts the aging process. Ned discusses how senolytics may delay, prevent, treat, or even reverse age-related diseases, including cancer, cardiovascular disease, and neurodegenerative disease. As a serial entrepreneur, Ned also provides advice on how to transform a simple idea into the creation of a company. We discuss: Defining longevity and the principles of aging [2:50]; The control knobs of aging and how we can turn them [15:10]; Role of cellular senescence in aging and cancer [27:00]; History of senescence in scientific study [40:30]; The cellular senescence paradox [46:00]; Developing medicines that target cellular senescence [52:15]; Ned's lessons on risk analysis in business [1:05:15]; The search for a molecule that could eliminate senescent cells [1:15:15]; Senescent cell elimination example in osteoarthritic knees [1:30:30]; Extending lifespan by removing senescent cells [1:45:00]; Senolytic molecule example in macular degeneration reversal [1:52:30]; The future of senescent cell targeting [1:58:30]; The role of cellular senescence and metabolic syndrome [2:01:30]; The role of cellular senescence and brain health [2:03:30] What prepared Ned to start Unity Biotechnology [2:05:45]; Advice for someone deciding between business and academics [2:08:50]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/neddavid 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.

In this "Ask Me Anything" (AMA) episode, Peter explains his framework for understanding what lab tests can (and cannot) inform us as it pertains to overall longevity, with a specific focus on atherosclerosis, cancer, Alzheimer's disease, and the physical body. Additionally, Peter shares details into two patient case studies around cardiovascular disease, including how the lab results influenced his diagnosis and treatment plan for the patients. Once again, Bob Kaplan, Peter's head of research, will be asking the questions. If you're not a subscriber and listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #14 show notes page. We discuss: Important lab tests and reference ranges [2:35]; How lab testing fits into the overall objective of longevity [4:25]; A healthcare system set up to react to a disease rather than prevent it [8:00]; The four pillars of chronic disease, and the three components of healthspan [14:30]; Atherosclerosis—How much can labs tell us about risk? [18:00]; Coronary calcium score (CAC)—Interpreting results based on your age [24:15]; Cancer—What lab work can tell you, and the future of liquid biopsies [28:00]; Alzheimer's disease—What's driving Alzheimer's disease, and what labs can tell you about your risk [33:15]; Healthspan and the physical body—Where lab testing fits, the endocrine system, and zone 2 testing [39:00]; Summarizing the usefulness of lab testing—Where it gives great, reasonable, or lousy insight [43:15]; Patient case study—Elevated Lp(a): Understanding ApoB, and how cholesterol levels get reduced [45:30]; Patient case study—Familial hypercholesterolemia [59:30]; Coming up on a future AMA [1:10:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama14 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.

In this episode, Lew Cantley, Professor of cancer biology and Director of the Sandra and Edward Meyer Cancer Center at Weill Cornell Medical College in NYC, walks us through his amazing discovery of phosphoinositide 3-kinase (PI3K) and the implications for the care of patients with cancer. He explains various combinations of therapies being tested and used, including the possibility of pairing prescriptive nutritional therapies to increase the efficacy of drugs like PI3K inhibitors. Lew also explains the metabolic nature of cancer through the lens of his research into the connection between sugar consumption, insulin resistance, and tumor growth. Additionally, Lew provides some details about his exciting new clinical trial that is just now enrolling patients with stage 4 breast cancer and endometrial cancer. We discuss: Teaching science through the lens of discovery—A better approach to learning science [5:15]; The metabolic nature of cancer, mitochondria, and a more nuanced explanation of the Warburg Effect [8:30]; The observation that convinced Lew to stop eating sugar [20:15]; The connection between obesity, insulin resistance, and cancer [25:30]; Sugar consumption and tumor growth—What did Lew's 2019 paper find? [32:00]; Natural sugar vs. HFCS, fruit vs. fruit juice, insulin response and cancer growth [43:00]; Increasing efficacy of PI3K inhibitors with ketogenic diets, SGLT2 inhibitors, and metformin [53:30]; Lew's clinical trial enrolling stage 4 breast cancer and endometrial cancer patients [1:07:30]; Pairing diet with drug could be the future of cancer treatment [1:09:30]; PI3K inhibitors on the market, alpha vs. delta isoform, and the possibility of pairing them with a food prescription [1:16:15]; What questions will Lew be focused on in the next chapter of his career? [1:22:15]; Lew's early work that ultimately led to the discovery of PI3K [1:27:30]; Studying the mechanism by which mitochondria make ATP [1:30:45]; How understanding the mechanism by which insulin drove glucose uptake into a cell got Lew closer to finding PI3K [1:38:15]; How Lew knew PI3K was important in driving the growth of cancer cells [1:55:00]; Lew's unlikely observation of phosphorylation at the 3' position of the inositol ring resulting in the formation of phosphatidylinositol-3-phosphate [1:59:00]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/lewcantley/ 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.

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

In this "Ask Me Anything" (AMA) episode, Peter explains some observations he's noticed since switching to a 3-day fasting cycle from the longer fasts, the various things he's measuring, and some helpful tips for getting through a prolonged fast. He also discusses the role of exogenous ketones in fasting and ketogenic diets as well as their impact on autophagy, specifically. Finally, Peter provides some practical advice for those looking to fit exercise for longevity into their busy life. Once again, Bob Kaplan, Peter's head of research, will be asking the questions. If you're not a subscriber and listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #13 show notes page. If you are not a subscriber, you'll be able to listen to a sneak peak of this episode. We discuss: Peter's observations since switching from a 7-day to a 3-day fasting regimen [1:25]; Ketone measuring devices—blood and breath [7:40]; Can zero-calorie sweeteners affect ketone production? [10:40]; Will there be a continuous insulin monitor anytime soon? [11:55]; Exogenous ketones—Role in fasting and ketogenic diets and their effect on insulin, blood glucose, and autophagy [14:10]; 5 tips to help you get through a multi-day fast [25:55]; Relationship between BHB levels, glucose levels, and autophagy—Are high levels of ketones enough to produce autophagy? [34:10]; Why is measuring blood insulin so much harder than blood glucose? [36:55]; Advice and resources for people wanting to stay up to date on developments related to health and longevity (and how to quickly sift through all the bad science) [40:10]; Advice for those looking to fit exercise for longevity into their busy life [51:10]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama13 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.

n this episode, John Barry, historian and author of The Great Influenza: The Story of the Deadliest Pandemic in History, describes what happened with the 1918 Spanish flu pandemic, including where it likely originated, how and why it spread, and what may have accounted for the occurrence of three separate waves of the virus, each with different rates of infection and mortality. While the current coronavirus pandemic pales in comparison to the devastation of the Spanish flu, John highlights a number of parallels that can be drawn and lessons to be learned and applied going forward. We discuss: What got John interested in the Spanish flu and led to him writing his book? [2:45]; Historical account of the 1918 Spanish flu—origin, the first wave in the summer of 1918, the death rate, and how it compared to other pandemics [10:30]; Evidence that second wave in the fall of 1918 was a mutation of the same virus, and the immunity immunity protection for those exposed to the first wave [18:00]; What impact did World War I have on the spread and the propagation of a "second wave"? [21:45]; How the government's response may have impacted the death toll [26:15]; Pathology of the Spanish flu, symptoms, time course, transmissibility, mortality, and how it compares to COVID-19 [29:30]; The deadly second wave—The story of Philadelphia and a government and media in cahoots to downplay the truth [35:50]; What role did social distancing and prior exposure to the first wave play in the differing mortality rates city to city? [44:45]; The importance of being truthful with the public—Is honesty the key to reducing fear and panic to bring a community together and combat the socially-isolating nature of pandemic? [46:15]; Third wave of Spanish flu in the spring of 1919 [51:30]; Global impact of Spanish flu, a high mortality in the younger population, and why India hit so much harder than other countries [55:15]; What happened to the economy and the mental psyche of the public in the years following the pandemic? [59:20]; Comparing the 2009 H1N1 virus to Spanish flu [1:02:10]; Comparing SARS-CoV-2 to the Spanish flu [1:04:20]; What are John's thoughts on how our government and leaders have handled the current pandemic? [1:08:00]; Sweden's herd immunity approach, and understanding case mortality rate vs. infection mortality rate [1:10:40]; What are some important lessons that we can apply going forward? [1:13:00]; Does John think we will be better prepared for this in the future? [1:16:00]; and More Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/johnbarry 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.

In this episode, infectious disease and pandemic preparedness expert, Amesh Adalja, M.D., puts the current pandemic into context against previous coronaviruses as well as past influenza pandemics. Amesh also provides his interpretation of the evolving metrics which have contributed to big variations in modeling predictions, whether this will be a seasonally recurring virus, and perhaps most importantly—how we can be better prepared for the inevitable future novel virus. Finally, Amesh explains where he sees positive trends which give him reasons for optimism. We discuss: Amesh's background in infectious disease [2:40]; When did the virus actually reach the US? And when did Amesh realize it would pose a real threat to the US? [4:00]; Comparing and contrasting COVID-19 to previous pandemics like the Asian flu of 1958 and the Spanish flu of 1918 [8:00]; Will COVID-19 be a recurring seasonal virus every year? [14:00]; Will a future vaccine be specific to this COVID-19 or will it also cover previous coronaviruses as well? [15:15]; What does Amesh think might be the true case fatality rate of SARS-CoV-2? [16:15]; Why did early models over predict infections and deaths by order of millions? [18:30]; Role of government—How does Amesh view the role of local versus central government in dealing with a future pandemic? [21:50]; What went wrong with testing and how could we have utilized it more effectively? [25:15]; Future pandemic preparedness—why Amesh is cautiously optimistic [27:30]; Should there be different policies and restrictions for places like New York City compared to less populated and less affected places across the US? [30:15]; Why mass gatherings might be disproportionately driving the spread of the virus [32:30]; Learning from HKU1, a lesser-known novel coronavirus from 2005 [34:00]; Thoughts on Sweden's herd immunity approach [36:10]; The efficacy of masks being worn in public and what role they will play as restrictions are slowly lifted [37:20]; What are some positive trends and signs of optimism? [39:15]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ameshadalja 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.