The Peter Attia Drive

Today's episode of The Qualys is from podcast #26 – AMA #3: supplements, women's health, patient care, and more. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/ Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

In this episode, David Light, CEO of Valisure (the company which alerted the FDA to the Zantac cancer concerns), explains the story behind the recent recalls by manufacturers of ranitidine, a common heartburn medication, sold under the trade name Zantac, due to a potential link to increased cancer risk. David breaks down all the evidence, the role of his unique pharmacy company which tests all its drugs before being dispensed to consumers, and the reason behind the FDA's tempered reaction to the alarming study results. David makes the argument that Zantac/ranitidine is an inherently unstable molecule which explains the grossly excessive amounts of NDMA (a probable human carcinogen) as opposed to just a contamination for which there could be numerous causes. Finally, David and Peter both provide recommendations for what to do if you or someone you know is currently taking Zantac/ranitidine. We discuss: The impetus for starting Valisure, a unique online pharmacy that tests all its medications [6:45]; The story behind the recall of valsartan, and the role which Valisure played [24:30]; Testing Zantac: The shocking results from Valisure's initial testing with major potential cancer implications [36:00]; NDMA - the probable human carcinogen found in Zantac/ranitidine [48:45]; The epidemiology question: Are we inferring too much from epidemiology? What can we take away from the existing studies? [53:30]; The staggering results from the 2016 Stanford study, why it didn't alarm more people, and how Valisure found the missing biological link [1:01:30]; Alerting the FDA, the FDA's tempered response, and question of contamination vs. inherent instability [1:07:30]; How confident is David that the elevated levels of NDMA being found in ranitidine are not due to instrumentation, human error, or temperature contamination? [1:24:15]; The massive risk being taken by the FDA by not doing more to keep ranitidine away from consumers [1:25:15]; If someone is taking Zantac/ranitidine, what should they do? What else do they need to know? [1:27:45]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/davidlight/ 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.

Today's episode of The Qualys is from podcast #15 – Paul Conti, M.D.: trauma, suicide, community, and self-compassion. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/ Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

In this episode, Jason Fried, co-founder of Basecamp, shares his beliefs around achieving business success in a modern world which tends to disproportionately focus on the massive success stories (the outliers). Jason gives his honest take on companies like WeWork, Uber, and Lyft that may give off the appearance of wild success but may instead provide an example of the dangers of perverse incentives. We get into Jason's backstory, and how his affinity for optimizing efficiency and production in the workplace culminated with the creation of Basecamp, his very successful web-based project management software business. Perhaps most importantly, we get really deep into all aspects of work-life balance and what it really means to "work hard" (Stay tuned for an AMA-style deep dive into the topic of work-life balance with Jason in the near future). In addition, Jason provides many more valuable nuggets including thoughts on some common mistakes made by businesses today, the value of giving employees autonomy, how to take the right types of risks, why he doesn't set any goals, and much, much more. We discuss: Jason's background and his early entrepreneurial spirit [9:45]; Views on completing higher education and the notion of hard work [24:00]; Beliefs around success in business [35:00]; WeWork, Uber, and Lyft: Poor business practices and the dangers of perverse incentives [41:30]; Jason's early career: his redesign approach and personal motivation [56:00]; The genesis of Basecamp [1:10:00]; Why Jason does not set goals but instead focuses on a vision [1:12:15]; Workplace motivation and hiring practice [1:20:30]; The importance of luck and not overworking [1:32:00]; A framework to work less and optimize for workplace autonomy [1:38:00]; The importance of saying 'no' more often (and tips for doing so) [1:55:00]; A shared passion for watches [2:03:30]; Guarding against the perils of phone addiction [2:08:45]; Jason's views on email and chat for communication [2:15:00] and; More. Learn more: https://peterattiamd.com/ Show notes page for this episode:peterattiamd.com/jasonfried 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.

Today's episode of The Qualys is from podcast #15 – Paul Conti, M.D.: trauma, suicide, community, and self-compassion. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/ Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

In this "Ask Me Anything" (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter's head of research, asks the questions. If you're not a subscriber and listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed. You can also watch (or listen) to this full episode on our website at the AMA #9 show notes page. Questions continue to be pulled from the AMA section on the website, and any subscriber is welcome to submit questions for future AMAs. We discuss: The story of how Peter almost worked for Theranos [2:00]; The trend of lower testosterone and higher estrogen in men: Why is it happening and what to do about it? [10:00]; Takeaways from Peter's recent hunting trip in Hawaii [14:45]; What books are you currently reading/listening to? [21:30]; What advice would you give to the 25 year-old Peter? [24:00]; What is your emergency protocol if you start getting sick? [27:45]; How have your thoughts changed on NAD precursors, and also on metformin, in the past year or so? [30:30]; What are your thoughts on "fat burning" zones for cardio workouts? — A lesson in relative vs. absolute fat combustion [34:15]; What mental models do you use and how do you go about solving problems and approaching difficult questions? [49:00]; Creatine supplementation—Yay or nay? Why? [49:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama09/ 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, Dan Harris, correspondent for ABC News and co-founder of the Ten Percent Happier meditation app, speaks openly about his struggles with self-centeredness, addiction, depression, emotional volatility, and the deep-rooted insecurities that drove him to career success. He tells the story of how a panic attack on live TV lead him down a path of self-discovery culminating in a meditation practice which has since transformed his life—in terms of his own personal suffering, his relationships with those closest to him, and his ability to be kind and compassionate (which has its own selfish advantages). Dan also shares some very practical advice and tips for new meditators, dispels some of the myths around meditation, and gives people some things to look forward to as they progress with their practice. Last but not least, we talk about the importance of not passing shame and trauma to our kids and the role that mindfulness and meditation plays in that. Dan's meditation book, and the panic attack on live TV that started it all [8:00]; Addiction: the spectrum of addiction, the socially acceptable forms, and Dan's own battle with addiction and depression [13:30]; Dan's drive for self-protection, a defining moment of childhood, and how his upbringing shaped him [20:30]; A selfish reason to be kind and compassionate [28:30]; Using mindfulness to avoid being controlled by your emotions such as anger and grandiosity [36:15]; How Dan found meditation, and how he went from skeptic to someone willing to try it [40:45]; Advice for new meditators, misconceptions about meditation, and the difference between changes in state vs. changes in trait [48:00]; Difference between being "mindful" versus being "present" [55:00]; The overlap between psychology and Buddhism, who is the real Buddha, and a Buddhism 101 lesson [57:45]; What convinced Dan to finally try meditation, and how did his first session go? [1:05:30]; Lessons from Dan's 10-day silent retreat: "You're trying too hard" [1:12:30]; How Dan's meditation has evolved over 10 years of practice [1:27:30]; Dan's 360 Review: A painful process illuminating his selfishness, and putting him on a path to more kindness and compassion [1:30:45]; How to quiet mental suffering in tough times, and how meditation has helped (and not helped) Dan get through some of the hardest moments of his life [1:41:30]; How Dan's practice has made him a better husband [1:47:45]; How to prevent the transference of trauma and shame to your kids [1:50:45]; Does past trauma drive successful people? Can a person be successful professionally if they give up that negative insecurity that is driving them? [1:56:00]; The pillars of emotional health, and how to help yourself when you feel insecure [2:08:30]; Why it's important to let your kids see that you are a flawed human [2:11:30]; Learning from the incredible (but flawed) Peter Jennings [2:15:15]; When is Dan's next book coming out? [2:21:15]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/danharris/ 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.

Today's episode of The Qualys is from podcast #26 – AMA #3: supplements, women's health, patient care, and more. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/ Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

In this episode, Katherine Eban, investigative journalist and author of Bottle of Lies, illuminates the prevalence of fraud in generic drug manufacturing which brings into question the idea that generics are identical to brand-name drug as we are lead to believe. Katherine walks us through how this widespread corruption came to be, including the shocking story of one particularly egregious (and unfortunately not uncommon) example of an Indian drug company, Ranbaxy, whose business model was completely dependent on falsifying data in their drug applications to the FDA. We then discuss the subsequent investigation into Indian and Chinese drug manufacturing plants which revealed that nearly 80% of them are tainted with fraud. We conclude this discussion on a positive note with i) how individuals can investigate their own drugs to protect themselves ii) an innovative pharmacy attempting to disrupt the market and iii) some ideas on how to reform to the regulations around generic drugs, the FDA, and more. We discuss: How Peter found Katherine's book, and what convinced her to investigate the generic drug industry [5:45]; Branded vs. generic drugs: Why they aren't the same thing [11:15]; The Food and Drug Administration: Why it was originally created and what it does today [20:45]; How the generic drug industry really got its start in the U.S., and the flaw of the Hatch-Waxman Act [28:20]; PEPFAR: How a well-intentioned plan to help Africa with the AIDS epidemic laid the groundwork for corruption [36:30]; The story of Ranbaxy: An Indian drug company whose business model was fraud and deceit [40:45]; How the FDA approves drugs, the impact of "first to file", and Peter's tangent on moral corruption [47:30]; A booming generic drug market and the FDA struggling to keep up [57:15]; Dinesh's internal investigation finds widespread fraud and falsified data inside Ranbaxy [1:00:15]; Presenting the famous SAR document to Ranbaxy's board of directors which spells out the company-wide fraud [1:09:15]; Dinesh blows the whistle on Ranbaxy which leads to a raid on their US plant [1:19:45]; Formal investigation of Ranbaxy is launched, but the FDA keeps approving Ranbaxy drug applications [1:33:30]; What role does the culture in India play in the high prevalence of fraud in the drug industry? [1:41:00]; The extreme prevalence of data fraud/manipulation in foreign generic drug factories [1:52:30]; Concluding the Ranbaxy story [2:06:15]; How concerned should you be when buying a generic drug from your local pharmacy? [2:11:15]; How to investigate your own drugs for quality to ensure you are getting what you need [2:18:30]; An innovative pharmacy that tests all its drugs for quality [2:24:45]; Reforming the FDA and generic drug industry: Why we need reform and ideas on how to do it [2:27:45]; The importance of taking individual ownership and not waiting for Congress to bail us out [2:34:00]; Closing thoughts from Katherine [2:36:50]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/katherineeban/ 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.

Today's episode of The Qualys is from podcast #18 – Richard Isaacson, M.D.: Alzheimer's prevention. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/ Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

In this episode, David Sinclair, Ph.D., a Professor in the Department of Genetics at Harvard Medical School and co-Director of the Paul F. Glenn Center for the Biological Mechanisms of Aging, returns to the podcast to discuss the content of his new book, Lifespan: Why We Age - and Why We Don't Have To. This conversation focuses on the biological mechanisms involved in what David terms the Information Theory of Aging which provides insights into the "clock" that determines our aging and to what degree it can be manipulated. Our discussion on aging of course leads us into interconnected topics of epigenetics, sirtuins, cellular senescence, as well as what compounds David is personally taking for his own longevity. Additionally, we discuss the most up to date information related to NAD and longevity by looking at the potential benefits (if any) of supplemental agents (NAD precursors, NR, NMR, etc.) that pose a promise of increasing NAD. We discuss: SIR genes and cellular identity [8:45]; Sirtuins regulate gene expression [14:30]; DNA is methylated at the deepest layer of the epigenome [17:45]; Methylation pattern and determining cellular age [20:15]; Cellular reprogramming [33:45]; Yamanaka factors to push cells "back in time" [41:00]; Human cellular reprogramming viability [57:00]; Measuring the rate of aging [1:02:45]; Cellular reprogramming for longevity [1:14:45]; Compounds David takes for his own longevity [1:29:15] NAD precursors (NR, NMN) and pterostilbene [1:40:00]; The current field of sirtuin activators [2:03:15]; David's artistic work [2:05:15] and; More. Learn more: https://peterattiamd.com/ Show notes page for this episode:https://peterattiamd.com/davidsinclair2/ 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.

Today's episode of The Qualys is from podcast #27 – David Sinclair, Ph.D.: Slowing aging – sirtuins, NAD, and the epigenetics of aging. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/ Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

In this episode, Dr. Ronesh Sinha, a physician, author, and educator based in Silicon Valley, shares his many insights into metabolic illness that he has gleaned from his South Asian patient population. In this conversation we focus on hyperinsulinemia, insulin resistance, metabolic dysregulation, inflammation, blood pressure, obesity, etc. and ways to address them with nutrition, sleep, exercise, stress management, and more. We also take a deep dive into insulin resistant phenotypes, evolutionary theory and geographic determinants of insulin resistance which provides insight into the genetic architecture and pathophysiology of metabolic syndrome. Additionally, we discuss the surprisingly interrelated topic of stress, and how we might be inadvertently passing this on to our children, leading to mental and physical sickness down the road. We discuss: How a stubborn case of insulin resistance connected Peter with Ronesh [7:15]; Ronesh's clinical treatment focus of metabolic illnesses in South and East Asian patient populations [8:45]; The distinction between visceral fat and subcutaneous fat stores [15:00]; Shortcomings of a body mass index (BMI) calculator for evaluating metabolic disease risk [17:15]; Cortisol and blood glucose variability [28:30]; Insulin's role in elevated blood glucose: A symptom of metabolic syndrome [33:25]; Mechanistic explanations of insulin resistance (there may be more than one) [35:15]; Theories on origins and evolutionary reasons for insulin resistance [40:00]; The inverse relationship between the amount of brown adipose tissue and rates of insulin resistance, and the role of climate in patterns and prevalence of insulin resistance [49:50]; Vitamin D levels, hyperinsulinemia, and other effects [53:45]; The evolutionary benefit of being able to turn fructose into fat (and the price we are now paying for it) [58:00]; The VO2 max relationship to insulin resistance and familial metabolic health [59:30]; Using zone 2 fitness test to evaluate mitochondrial performance [1:01:15]; Exercise for long-term functional health [1:06:00]; Lifestyle changes to improve insulin resistance and other metabolic phenotypes [1:14:00]; Is PCOS a manifestation of insulin resistance? [1:21:00]; The impact of stress on adiposity, and Peter's treatment regimen for overweight females resistant to typical nutritional approaches [1:23:45]; How a culture of achievement and expectations can lead to undue stress, unhappiness, and health problems in our children (a Silicon Valley case study) [1:35:00]; The negative impact of devices and social media on children [1:48:45]; How you can help yourself, your family, and your community without being an MD or PhD [1:55:00]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode:https://peterattiamd.com/roneshsinha/ 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.

Today's episode of The Qualys is from podcast #18 – Richard Isaacson, M.D.: Alzheimer's prevention. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/ Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

In this episode, Marty Makary, Johns Hopkins surgeon and NYT bestselling author, discusses his ambitious attempt to fix the broken U.S. healthcare system through educating the public, changing the lexicon, encouraging radical transparency in pricing, and more. We go in detail into the main drivers of inflated health care costs, the money games being played making it hard to understand, and the unfortunate system structure that has resulted in one in five Americans finding themselves in medical debt collections which can ruin the lives of people and families seeking basic medical care. Marty also shares some very practical advice and tips if you find yourself a victim of predatory pricing and stuck with an outrageous medical bill. In the end, despite the current state of the system, Marty discusses the many exciting trends gaining traction in healthcare and why he is very optimistic and hopeful about the future. We discuss: The science of delivering healthcare, how we need to do better as a system, and why no single person or entity fully to blame [10:15]; The stories that prompted Marty to write his first book (Unaccountable) [19:15]; The Surgery Checklist [26:15]; The problem is with the system (not any one person or entity) and the misaligned interests of all the parties involved [28:15]; Patients crave honesty and transparency, and the story of Peter's back surgery gone wrong [33:00]; Today's med students and young doctors have less tolerance for predatory pricing and healthcare industry BS [44:30]; Funny stories about John Cameron (legendary surgeon at Johns Hopkins) [48:00]; How doctors are trained to internalize traumatic experiences which can result in a misunderstood form of "burnout" [57:40]; The beat down of med students with traditional medical education and some exciting innovations to medical education [1:07:00]; Exciting trends in healthcare and an optimistic view of the future [1:11:30]; The Price We Pay (Marty's new book), an attempt to illuminate the blackbox that is the US healthcare system [1:21:00]; Why it's not always in the best interest of the insurance company to negotiate the best price [1:28:30]; Who is actually paying for medical costs, and Marty's frustration with the healthcare lexicon [1:32:00]; Pros and cons of a single payer system [1:37:00]; How to fight outrageous medical bills and predatory pricing (and make a dent in the wasteful healthcare spending for the country) [1:49:30]; Disrupting the healthcare industry with private healthcare facilities with market demanded transparency [2:05:45]; The people hurt the worst by the current US healthcare system, the sad breast cancer statistic, and the importance of knowing that medical bills are negotiable [2:09:30]; The healthcare industry bubble [2:14:00]; Increased costs from unnecessary tests and procedures [2:16:30]; Malpractice concerns due to the litigious culture in America: What influence does it have on unnecessary testing, healthcare costs, and overall quality of treatment [2:22:00]; Drug pricing, price gouging, middle-men money games, kickbacks, and other drivers of healthcare costs [2:27:45]; How can we possibly fix the healthcare system? [2:34:30]; Helpful resources [2:46:15]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode:https://peterattiamd.com/martymakary/ 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.

Today's episode of The Qualys is from podcast #02 – Rhonda Patrick, Ph.D.: the performance and longevity paradox of IGF-1, ketogenic diets and genetics, the health benefits of sauna, NAD+, and more. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/ Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

In this "Ask Me Anything" (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter's head of research, asks the questions. If you're not a subscriber and listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed. You can also watch (or listen) to this full episode on our website at the AMA #8 show notes page. Questions continue to be pulled from the AMA section on the website, and any subscriber is welcome to submit questions for future AMAs. We discuss: Do DNA kits provide actionable info for cancer, CVD, diabetes, Alzheimer's, nutrition, or exercise? [1:45]; What genes increase longevity? And do those genes show up on genetic tests like 23andMe? [12:00]; Who are some people that Peter would like to have as guests on The Drive? [15:00]; Inflammation: Is CRP a useful marker? What can one do to reduce it? And what other inflammatory markers can I look at to gauge health? [18:30]; What lipid test does Peter now use on his patients? What are the three best cardiovascular laboratories? [28:00]; Metformin for longevity: What considerations should one think about before doing taking metformin for longevity purposes? [32:30]; What is Peter's take on salt and its role in things like high blood pressure and stomach cancer? [40:00]; What markers does Peter find most interesting (and surprising) during his quarterly fasts? [47:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode:http://peterattiamd.com/ama08 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.

Today's episode of The Qualys is from podcast #04 – AMA #1: alcohol, best lab tests, wearables, finding the right doc, racing, and more. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Learn more: https://peterattiamd.com/podcast/qualys/ Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

In this episode, Dr. Vamsi Mootha, an expert in mitochondrial biology and investigator at the Howard Hughes Medical Institute, shares his breadth of knowledge on the mitochondrion organelle: its history, function, genome architecture, and his research of rare mitochondrial dysfunction. Vamsi is currently focused on finding clinical treatments for the 300-some identified rare disorders, but in this work there is a wealth of potential implications in the context of longevity and chronic disease. In this conversation, Vamsi elucidates how the latest research could give insight into conditions related to aging, including but not limited to Alzheimer's disease, Parkinson's disease, insulin resistance and type 2 diabetes, cancer, and much more. We also explore some of the most exciting potential therapies for mitochondrial diseases such as hypoxia (oxygen deprivation), how exercise affects the mitochondria, the use of hyperbaric chambers for cancer therapy, and the mechanisms by which Metformin might confer longevity benefits in a non-diabetic individual. We discuss: The Broad Institute of MIT and Harvard [8:00]; Vamsi's academic background [10:30]; Advice for college students and med students considering a career in medicine and/or medical research [15:30]; Vamsi's focus on mitochondria and mitochondrial disorders [20:00]; The mitochondrial genome: Lineage, endosymbiosis, and reductive evolution [23:15]; How many diseases can be attributed to mitochondrial mutations? [28:45]; Nuclear DNA and mtDNA: Roles, interaction, communication, and biogenesis [31:30]; Which cells have the most mitochondrial DNA? And how often does mitochondria turn-over in a cell? [37:30]; Does ALL of your mitochondrial DNA come from your mother? [40:00]; Mitochondria 101: The powerhouse of the cell, electron transport chain, and the NADH/NAD ratio [44:00]; NAD and NADH: Role in the mitochondria, decline of NAD levels with age, and what it means to age at a mitochondrial level [51:30]; Mitochondrial diseases Vamsi studies in his lab [55:15]; Mitochondria and oxygen: Poor oxygen utilization and excess oxygen contributes to the pathology seen in some of the rare mitogenic diseases [1:02:00]; What VO2 max can tell us about mitochondrial function, insulin resistance, type 2 diabetes, and more [1:10:00]; Can studying mitochondrial disease provide insights into the common forms of aging? [1:18:45]; Could muscle cell inflammation (a signature of aging) be caused by mtDNA damage being confused as foreign bacteria? [1:22:00]; Exercise and mitochondrial health: Is there an optimal exercise strategy to slow the aging process? [1:27:00]; What autophagy means in the context of mitochondria [1:36:15]; Metformin's impact on exercise and lactate levels [1:40:15]; How might metformin confer longevity benefits? [1:48:15]; Hypoxia as a potential therapeutic option for mitochondrial disease [1:52:45]; Cancer prevention and treatment: hyperbaric oxygen chambers, targeting single carbon metabolism of the mitochondria, and more [2:00:00]; Chronic diseases have altered mitochondria: Evidence for mitochondrial dysfunction causing Parkinson's disease [2:04:30]; Why Vamsi is very optimistic about the possibility of targeting mitochondrial proteins as therapies [2:09:30]; Is it theoretically possible to genetically engineer a better functioning mitochondria? [2:14:30]; Vamsi's fantasy experiment in an unconstrained world [2:20:15]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/vamsimootha/ 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.

Today's episode of The Qualys is from podcast #04 – AMA #1: alcohol, best lab tests, wearables, finding the right doc, racing, and more. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/ Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

In this episode, Rick Doblin, founder and executive director of MAPS, discusses MDMA, a molecule that has (at a minimum) revolutionary therapeutic benefits for PTSD, but arguably could have, at the highest order, a lasting impact on humanity's ability to peacefully coexist. Rick details the history of MDMA, what lead to its unfortunate criminalization, and his lifelong work trying to protect MDMA (and other psychedelics) from criminalization (and his subsequent attempt to decriminalize it). Through his founding of MAPS, Rick has made enormous progress in debunking many of the exaggerated risks being claimed against MDMA (neurotoxicity, memory loss, depression, Parkinson's, etc.), and is very close to getting FDA approval for a psychotherapy technique using MDMA. Additionally, in this discussion, you will learn about the history of LSD, psilocybin, and other psychedelics and how the combination of the misunderstanding of them with the crackdown on drug use in the 1970s lead to their designation of schedule 1 substances. But it's important to note that you will also realize from this discussion just how different MDMA is compared to the average psychedelic. We end this discussion with a message of hope: there are going to be many people who are going to wonder what can they do to receive this MDMA therapy. We talk about what those clinical trials look like, what the enrollment looks like, and perhaps more importantly, what a compassionate use license would look like, such that if there are patients who are in need of this therapy (prior to its approval) they can have an understanding of the legal paths to doing just that. We discuss: Discovering MDMA, how Rick learned about it and his first experiences with it [9:45]; The timeline of MDMA's evolution, the reinvention in the 1970s, "ecstasy", the criminalization of MDMA [21:10]; Explaining the different "schedules" of drugs [30:55]; Rick's fight to protect it for therapeutic uses, losing to the DEA despite winning in the court, the scientific community, and the media [38:25]; The risks involved with taking MDMA [42:30]; An incredible MDMA-LSD case study: Rick's story of healing a treatment-resistant PTSD patient in the 1980s [44:45]; How and why MDMA was declared illegal on an emergency basis going against the judge's recommendation after hearing Rick's compelling case (and multiple appeals) in court [57:15]; Rick's decision to study politics to affect change from the inside out, and the recent progress being made with the DEA [1:07:00]; Debunking the exaggerated risks of MDMA (e.g., neurotoxicity) [1:16:30]; Rick's unbelievable ability to play the long game [1:28:45]; Which patients would not be good candidates for MDMA from a safety perspective? [1:34:30]; How MDMA is different from all other psychedelics, the importance of the setting, and Peter's experiences with MDMA [1:36:30]; MDMA studies which lead to the crucial designation as a "breakthrough therapy" [1:40:30]; How someone with PTSD can get treated now through "expanded access for compassionate use" [1:46:00]; Rick's ultimate goal and long term vision for psychedelic clinics [1:50:30]; Trip of Compassion documentary, and how psychedelics could change the world [1:52:30]; Rick's early life: Resisting the draft, his feeling of wanting to change the world, and his profound experiences with LSD and other psychedelics [1:55:30]; The history of LSD and psilocybin, and the CIA's interest in psychedelics [2:10:45]; Timothy Leary and the Good Friday Experiment [2:22:00]; Rick's follow up study to the Good Friday Experiment, and his criticism (and praise) of Tim Leary [2:33:50]; Peter's experience taking psilocybin [2:44:30]; The Concord Prison Experiment, and Rick's follow up study 34 years later [2:47:00]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/rickdoblin/ 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, board-certified plastic surgeon, Zol Kryger, enlightens us about the frighteningly loose laws regulating the industry of plastic surgery, paving the way for a majority of cosmetic procedures being performed by doctors that are not board-certified plastic surgeons. We talk about some of the very serious complications that can occur even in "minimally invasive" procedures, where the incidence rate is only increased by the flood of non-certified doctors who want to offer these procedures to augment their income. Fortunately, Zol provides listeners with a very specific list of important questions to ask a surgeon when considering any of the many cosmetic procedures available. We then go into the specifics of the most common procedures and the risk of complications for each of them, including breast augmentation, tummy tucks, liposuction, Brazilian butt lifts, botox and fillers, facial peels and lasers, and more. By the end of this episode, you'll have a really clear understanding of what these risks are and how you can go about reducing those risks by choosing the right physician. We discuss: Why Zol chose plastic surgery [7:30]; The shockingly high percentage of plastic surgery being done by non-board certified doctors, and the laws that allow it to happen [11:20]; 10 Questions to Ask Your Cosmetic Surgeon (PDF Download) [21:00]; Complications: Why you must ask your doctor about potential complications and how they would deal with them [24:20]; Zol's first complication, how he dealt with it, and how having a partner to check your work is great for the doctor and patient [32:30]; Breast augmentation: What you need to know—types of implants, complication rates, and Zol's summary of the safest and most effective way to do it [39:10]; Breast reconstruction following a mastectomy [1:06:30]; Tummy tuck: How it's done, biggest risks involved, scarring, and how it can address hernias and diastasis [1:13:00]; Liposuction: How it works, the potential complications and risks involved, and the importance of choosing the right doctor in the "wild west" of liposuction [1:26:45]; Butt lifts: Rising popularity, major risks, the frighteningly loose laws regulating the industry, and how the butt lift industry is eerily similar to the subprime mortgage crisis [1:37:00]; What is it about plastic surgery (and not other segments of medicine) that compels (and allows for) untrained doctors to offer these procedures? [1:49:45]; Peter asks Zol if he ever feels emotionally conflicted working in an industry that sometimes can feed off the vanity and insecurity of people [1:56:25]; Does Zol ever turn down patients? [2:02:45]; The risks involved with botox, fillers, facial peels, and laser treatments [2:07:45]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/zolkryger/ 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 answers a wide range of questions from subscribers. Bob Kaplan, Peter's head of research, asks the questions. If you're not a subscriber and listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed. You can also watch (or listen) to this full episode on our website at the AMA #7 show notes page. Questions continue to be pulled from the AMA section on the website, and any subscriber is welcome to submit questions for future AMAs. We discuss: What can I do to prevent/reduce interruptions in sleep due to needing to get up to urinate at night? [3:00]; Peter's note card system for organizing his to-do lists [7:15]; How do I get smarter at reading/understanding the studies (or the media's interpretation of them) that get the headlines on health and/or disease? [11:15]; How can I obtain a continuous glucose monitor (CGM) as a non-diabetic individual? [11:55]; What is the most effective way to bring blood pressure down? [15:00]; Does Peter use any nootropics? [28:10]; Peter's thoughts pertaining to concussions and head trauma [33:00]; Does Peter structure his exercise plan for lifespan or healthspan? [36:45]; How did Peter rebuild his lower back strength after his devastating injury during med school? [38:15]; Peter's approach to deadlifting with a bad lower back [43:25]; Did Peter cave and buy a dog? [51:50]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this episode, Keith Flaherty, director of clinical research and targeted cancer therapy at Massachusetts General Hospital, shares his vast wealth of knowledge in cancer starting with the history of treatment from chemotherapy to radiation to surgical therapy and where those methodologies seemed to have leveled off. He also walks us through the timeline of advancements (and lack there of) from when the War on Cancer was declared in the 1970s, through the sequencing of the entire human genome, and all the way to today. Keith dives into the topic of immunotherapy, probably the most exciting recent development in cancer therapy, and also provides us a rundown of his notion of a different approach to cancer that attacks all the essential pillars of cancer growth and survival. Finally, we talk a little bit about liquid biopsies, we discuss the roles of CRISPR and other potentially over-hyped therapies with respect to cancer. We also touch on stem cell therapy a bit, as well as some other common cancer-related questions such as the role of vitamin D and sun exposure in melanoma, and much more. We discuss: Growing up around medicine, and finding a career that you love [7:30]; Medicine as a career, limitations of the med school teaching approach, and the dynamic and accelerating field of medicine and technology [16:30]; Explaining chemotherapy, radiation, and how a cancer develops [23:45]; Surgical oncology, cure rate of solid tumors, and survival rate after tumor removal [33:15]; 25 years after the War on Cancer is declared, gene sequencing, and why Keith's was fascinated by the HIV case study [37:15]; Cancer immunotherapy: History, how it works, and why some cancers respond and others don't [46:00]; MHC complexes, and cancer cloaking mechanisms [56:00]; Comparative biology of cancer: Why some cancer can evade immune detection better than others [1:03:00]; What we learned from the Cancer Genome Atlas Project [1:07:00]; Defining targeted therapy, HER2 breast cancer, chronic leukemia, and the translocation of chromosomes [1:12:00]; Tumor protein P53, the most famous tumor suppressor gene and its ubiquity in cancer [1:17:45]; Activated oncogenes, the RAS pathway, PI3 kinase, RAF gene, and Keith's "aha moment" [1:24:15]; Advice for starting your career as a scientist/clinician [1:37:00]; Fusion-driven cancers, targeted therapy, and the Bcr-Abl/chronic myelogenous leukemia case study [1:39:45]; Targeted therapy for fusion-driven solid tumors, adjuvant systemic therapy, and the HER2 breast cancer example [1:53:00]; Advancing melanoma treatment, survival, and cure rates with BRAF-MEK combo therapy [1:59:15]; The fundamental pillars of cancer growth and survival, and the toolkit we need to attack cancer from all angles [2:02:40]; Peter's clinical framework for thinking about cancer and how Keith might improve it, and how the biotech environment is hampering our ability to put together novel cancer treatments [2:05:00]; How useful is CRISPR in terms of tumor suppressing? [2:16:15]; Liquid biopsies as a therapeutic monitoring tool [2:18:00]; Stem cell therapy: The efficacy and potential risks [2:25:15]; Aging and cancer: Is cancer inevitable? [2:28:45]; Vitamin D supplements, sun exposure, melanoma, and exercise [2:32:30]; How and why Keith has straddled the line between science/research and industry/drug companies, and the importance of getting more voices of practitioners at the table [2:42:00]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this episode, radiologist/engineer, Raj Attariwala, explains how he was able to apply his engineering background to create a unique MRI scanner that is capable of constructing whole-body images with a resolution that is unmatched in the industry. Peter and Raj discuss the implications of such a robust, radiation-free imaging tool on the early detection of cancer. They dive deep into cancer screening and define terms such as sensitivity and specificity that are necessary to really understand this complex space. They then describe the biggest risks involved in this type of screening (false positives) and how Raj's unique technology and process might drive down this risk substantially. But before that, they discuss all the common imaging technology from X-ray, to CT scan, to PET scans, to ultrasound, to MRI, and more. They touch on the history of each, how they work, the usefulness and limitations of each of them, as well as the varying risks involved such as radiation exposure. If you are interested in cancer screening and/or you've ever wondered how any radiology tool works, this episode is for you. We discuss: Raj's road from engineering to radiology [7:45]; How X-ray works, the risk of radiation exposure, and the varying amounts of radiation associated with the different imaging technologies [18:00]; Computed tomography scans (CT scans): The history of CT, how it works, and why we use contrast [27:45]; Ultrasound: Benefits and limitations, and a special use for the heart [40:45]; Detecting breast cancer with mammography: When is works, when you need more testing, and defining 'sensitivity' and 'specificity' [51:15]; Magnetic resonance imaging (MRI): How it works, defining terms, and looking at the most common types of MRI [1:03:45]; Brain aneurysms: Using MRI to find them and save lives [1:23:45]; Raj's unique MRI technology [1:30:00]; The risk of false positives in cancer detection, and how Raj's MRI can reduce the number of false positives (i.e., increase specificity) [1:43:40]; The unique software Raj created to pair with his MRI machine [1:51:15]; Comparing the radiation exposure of a whole-body PET-CT to Raj's equipment (DWIBS-MRI) [1:53:40]; How diffusion-weighted magnetic resonance imaging (DW-MRI) has revolutionized cancer screening [1:55:15]; Why a DW-MRI is still not a perfect test [1:59:00]; The potential for advancing MRI technology: Where does Raj think it could improve in the next 5-10 years? [2:03:00]; Are there any commercially available scanners that can match the resolution of Raj's images? [2:06:00]; Machine learning: When and where might machine learning/AI impact the field of radiology? [2:08:40]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this anniversary episode, Olivia, Peter's daughter who initially kicked off The Drive podcast with her sneak peek episode, returns to ask Peter the tough questions on how the podcast is going, what he has learned along the way (and how he plans to make it better), what exciting things are in store for the future, and plenty more.

In this episode, former World Series of Poker champion and author, Annie Duke, explains how poker is a pertinent model system for decision making in the real world, a system which blends imperfect information with some unknown percentage of both luck and skill. We go through the decision-making matrix, and how we spend most of our energy focusing on just one of the four quadrants at the expense of the learning opportunities that come from the other 75% of situations. Annie also shares how this evaluation of only the bad outcomes (and our tendency to judge others more harshly than ourselves in the face of a non-status quo decision), leads individuals, leaders, and teams to avoid bad outcomes at all costs. This avoidance is at the cost of the types of decisions which lead to progress and innovation both personally, and societally, across many realms from poker to sports to business to medicine. We also dive deep into a framework for learning, and the levels of thought required to rise to the top of a given domain. Finally, we talk about something that resonated deeply with me in terms of how I think about extending healthspan, which is the concept of "backcasting". We discuss: Annie's background, favorite sports teams, and Peter's affinity for Belichick [7:30]; Chess vs. poker: Which is a better metaphor for decision making in life (and medicine)? [12:30]; Thinking probabilistically: Why we aren't wired that way, and how you can improve it for better decision making [18:15]; Variable reinforcement: The psychological draw of poker that keeps people playing [25:15]; The role of luck and skill in poker (and other sports), and the difference between looking at the short run vs. long run [38:00]; A brief explanation of Texas hold 'em [47:00]; The added complexity of reading the behavior of others players in poker [53:15]; Why Annie likes to "quit fast", and why poker is still popular despite the power of loss aversion [58:30]; Limit vs. no limit poker, and how the game has changed with growing popularity [1:01:00]; The advent of analytics to poker, and why Annie would get crushed against today's professionals [1:10:30]; The decision matrix, and the 'resulting' heuristic: The simplifier we use to judge the quality of decisions —The Pete Carroll Superbowl play call example [1:16:30]; The personal and societal consequences of avoiding bad outcomes [1:27:00]; Poker as a model system for life [1:37:15]; How many leaders are making (and encouraging) status-quo decisions, and how Bill Belichick's decision making changed after winning two Super Bowls [1:41:00]; What did we learn about decision making from the Y2K nothingburger? And how about the D-Day invasion? [1:46:30]; The first step to becoming a good decision maker [1:48:45]; The difference between elite poker players and the ones who make much slower progress [1:55:30]; Framework for learning a skill, the four levels of thought, and why we hate digging into our victories to see what happened [1:58:15]; The capacity for self-deception, and when it is MOST important to apply four-level thinking [2:06:15]; Soft landings: The challenge of high-level thinking where there is subtle feedback and wider skill gaps [2:16:45]; The benefits of 'backcasting' (and doing pre-mortems) [2:19:30]; Parting advice from Annie for those feeling overwhelmed (and two book recommendations) [2:28:30]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this episode, Jason Fung, nephrologist and best-selling author, shares his experiences utilizing an individualized approach to fasting to successfully treat thousands of overweight, metabolically ill, and diabetic patients, and why being a doctor who specializes in kidney disease gives him a unique insight into early indications of metabolic disease. We also have a great discussion on insulin resistance where Jason makes the case that we should actually think of hyperinsulinemia as the underlying problem. We also discuss the difference between time-restricted feeding, intermittent fasting, and dietary restriction (e.g., low-carb) and how they can be used to attack the root cause of T2D, metabolic syndrome, and obesity. We also have a fascinating discussion about the limitations of evidence-based medicine which leads to a conversation where we compare and contrast the scientific disciplines of medicine and biology to theoretical physics. We discuss: Comparing scientific disciplines: Medicine and biology versus physics [7:25]; The limitations of evidence-based medicine [12:30]; Early signs of metabolic disease: How specializing kidney disease gives Jason a unique insight into early indications of illness [20:50] Insulin resistance, hyperinsulinemia, and the overflow paradigm [29:30]; Why the common treatments for type 2 diabetes seem to make things worse [42:30]; How hyperinsulinemia (not insulin resistance) drives metabolic syndrome [53:15]; Insulin and weight gain, and using fasting to empty the cells of glucose [59:30]; The two step process of developing type 2 diabetes and how they are both manifestations of hyperinsulinemia [1:03:15]; NAFLD and hyperinsulinemia: A vicious cycle [1:08:30]; Are the features and symptoms of diabetes actually protective? [1:12:15]; Is obesity causing insulin resistance or is it the other way around? [1:17:30]; What role does inflammation play in obesity? [1:21:45]; CVD and cancer: Diseases of too much growth? [1:27:30]; How to reduce proliferation with rapamycin, nutrition, exercise, fasting, and manipulating hormones [1:32:45]; Getting patients to fast: How Jason and Peter utilize fasting in their practice, and how their approach differs [1:40:15]; Comparing bariatric surgery to fasting as a treatment for type 2 diabetes [1:48:00]; Why people think that fasting is bad for you [1:55:15]; Time-restricted feeding and intermittent fasting: Defining terms, and how Jason applies them in his practice [1:58:30]; A fasting case study: A diabetic patient with a non-healing foot ulcer [2:04:00]; Keys to a successful fast [2:12:45]; Muscle loss during fasting, and why Jason isn't worried [2:24:45]; Will fasting help a healthy person live longer? [2:31:30]; Does fasting cause gallstones? [2:38:45]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In the first three parts of our series with sleep expert Matthew Walker, Matt revealed the many reasons why we need sleep as well as the many short- and long-term dangers of not sleeping enough. In this special AMA episode, Matt comes back to provide a dissertation on listener's questions about HOW to sleep. He answers questions from subscribers that largely focus on the practical and tactical ways we can improve our sleep in terms of duration, quality, consistency, and avoidance of the common things that are standing in the way the best sleep possible. We discuss: Matthew's TED Talk, and his favorite public speakers [7:45]; How good are the current sleep trackers like Oura, Fitbit, etc.? [10:45]; Is it bad to eat food too close to bedtime? [15:30]; How does exercise impact sleep? [17:30]; How is appetite affected by our sleep quality? [21:30]; Anxiety, cortisol, and weight gain: An awful feedback loop of sleep deprivation [23:30]; How to optimize your wind down routine: lights, temperature, & relaxation [26:10]; How alcohol disrupts sleep (and contributes to Alzheimer's disease) [46:00]; Sleep's impact on sex hormones, and romantic relationships [50:00]; Performance, accuracy, and minimizing the damage of shift work [55:30]; Bed partners: How to sleep in separate beds and retain a good relationship [59:30]; Can we use sound machines and electrical stimulation to improve sleep? [1:02:40]; Will we ever be able to "supercharge" our sleep stages using technology? [1:08:30]; Why sleep is the best insurance policy for lifespan and healthspan [1:11:45]; Melatonin: How (and how not) to use it for sleep improvement [1:19:00]; The dangers of sleeping pills, useful alternatives, and cognitive behavioral therapy for insomnia [1:28:30]; Can CBD and THC be used for sleep? [1:43:30]; Why haven't we been able to develop a really effective sleeping aid? [1:50:40]; Can you get too much sleep? [1:55:50]; What to do (and not do) immediately following a terrible night of sleep? [2:09:15]; Why a consistent wake up time is king [2:14:30]; Does poor sleep speed up the aging process? [2:16:00]; Can different people be more (or less) resilient to sleep deprivation? [2:22:50]; Finding your optimal sleep schedule and determining your sleep chronotype [2:27:45]; Defining sleep efficiency and how to improve it [2:33:25]; Correcting insomnia: A counterintuitive approach [2:35:45]; How can parents improve the sleep of their kids? [2:41:30]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this episode, Rick Rubin, legendary music producer and co-founder of Def Jam Records and American Recordings, discusses his early foray into music production which started as a hobby as a teenager and ultimately turned into a Grammy award-winning career that produced revolutionary changes in the music industry. Rick has worked with the likes of the Beastie Boys, Red Hot Chili Peppers, and Johnny Cash, just to name a small fraction. Rick talks about the pain and suffering that sometimes drives music and the cycle of drug addiction and how he has been able to help artists through those struggles to make space for their creative genius. We also get into Rick's own personal health journey including his battle with depression, his struggle with obesity, and ultimately his extraordinary transformation. Finally, Rick shares a really significant health scare which required emergency heart surgery, and how that experience has impacted him. We discuss: Early career, and the birth of hip hop [7:15]; Early success of Def Jam Recordings, and working with LL Cool J [13:15]; Revolutionary changes in music: LL Cool J, Beastie Boys, and Run DMC [19:30]; Partnership with Columbia Records, and leaving Def Jam [26:45]; The success of Licensed to Ill: how it took off, and how it changed things [36:00]; American Recordings: Rick's transition to rock and roll [39:15]; Working with the Red Hot Chili Peppers, and the poetic nature of music [45:45]; Rick's favorite music that he did NOT produce [53:00]; Prevalence of drug use and emotional pain in musicians: Rick's experience with helping artists through their struggles [57:20]; NYC vs. LA hip hop [1:05:30]; Rick's battle with depression [1:10:00]; Coping with the death of artists that Rick worked with [1:22:00]; Working with Johnny Cash [1:26:45]; Working with Rage Against the Machine [1:34:30]; The digital age of music: Have we lost something? [1:37:45]; Rick's health journey and battle with obesity [1:42:45]; Radical weight loss: How Rick was finally able to shed the weight [2:00:15]; Total transformation: Exercise and training with Laird Hamilton [2:11:00]; Emergency surgery: Rick's frightening heart condition [2:25:30]; Methylene blue and exogenous ketones: Are they neuroprotective? [2:46:15]; The most profound thing Rick learned about himself from his heart condition and major surgery? [2:52:30]; What life lessons does Rick wish to impart on his son? [2:57:30]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In the second installment of this 2 part series, Jocko shares his sleep routine and attitude towards sleep, we talk about his meals (and occasional indulgences), his experience with fasting, and touch briefly on his workout routine. Jocko explains his approach to leading a family, instilling values in his kids, and working with others who may not share your same principles. We also find out what prompted Jocko to make discipline the underpinning principle of his life, when it might make sense to quit, and the philosophical topics such as free will, mindset, and whether or not you can change someone. We also discuss 9/11 and the war in Iraq and Afghanistan, the future of warfare, and perhaps more importantly, how Jocko's experience in combat has shaped and impacted his life to this day. We discuss: Where was Jocko when the 9/11 attack occurred? What did he think? [5:45]; How SEAL teams are structured, and which teams Jocko was on [10:45]; War in Afghanistan: Unique challenges, how it differs from Iraq, and the lessons learned [13:00]; Iraq War: Differing public opinions on war, Jocko's experiences in Iraq, strategic mistake of ISIS, and the Saddam regime [19:15]; The future of warfare: machine technology in war and medicine [27:30]; Raising kids, instilling values, and leading a family [33:45]; Sleep: Jocko's habits, routine, and attitude towards sleep [40:15]; When it makes sense to quit [53:30]; What makes Jocko different, the existence of free will, and whether or not you can change people [1:01:45]; How to work with people with a bad attitude and opposing mindset [1:07:45]; Does Jocko ever indulge? Favorite foods and treats [1:11:00]; Fasting and meal timing [1:16:30]; Olivia (Peter's daughter) interviews Jocko [1:21:45]; What prompted Jocko to start prioritizing discipline in his life? [1:22:15]; What does Jocko do in his workouts? [1:23:30]; Where did the nickname, Jocko, come from? [1:24:20]; Jocko's favorite book, his best advice, and secret to getting up early [1:25:50]; The impact that war had on Jocko [1:28:00]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In part 1 of this 2 part series, Jocko Willink, retired Navy SEAL, discusses some of his most important lessons learned from his time commanding some of the world's most expert special forces operators including the importance of understanding the objective and strategy (and then tactics) of a mission, why humility is the greatest trait a leader can have (and certain times when it's not), as well as the necessity of having proper protocols in place to deal with whatever comes your way. We also talk about how Jocko prioritizes his military and family obligations with his love for jiu-jitsu, as well as how to decipher what really matters in life. Finally, we go through the US history with respect to various wars from World War I, all the way forward, and much much more. We discuss: Objective, strategy, and tactics [6:00]; Training compared to actual combat [20:30]; The importance of humility in leadership, business, and life [33:00]; The dichotomy of human traits: Can you be too humble? [49:00]; Why many leaders lack humility [52:30]; Why Jocko wanted to be a Navy SEAL [55:00]; Jocko's attitude toward death, and dealing with the death of a soldier [58:45]; The vital importance of protocols [1:03:45]; Protocol for losing a child (or anyone close to you) [1:15:00]; Protocol for getting dumped, and some relationship advice [1:18:00]; How to differentiate between things that matter and things that don't [1:24:30]; Jocko shares his experience during BUD/S [1:35:45]; How Jocko prioritizes his family and SEALs obligations: Would Jocko come out of retirement and go back to war? [1:48:30]; America's lost sense of connectedness and purpose since WWII [1:59:00]; How warfare has evolved over the decades since WWI [2:05:40]; Obeying orders and the obligation to dissent [2:09:00]; WWI and WWII, the beginnings of "decentralized command" [2:15:00]; The American warrior mentality, and the impact of freedom on a society [2:20:45]; What impact can an individual president really have? [2:25:00]; The Korean war [2:29:15]; Lessons learned from Vietnam [2:31:10]; First Gulf War, Iraq War, and The War in Afghanistan [2:35:45]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram. In part 1 of this 2 part series, Jocko Willink, retired Navy SEAL, discusses some of his most important lessons learned from his time commanding some of the world's most expert special forces operators including the importance of understanding the objective and strategy (and then tactics) of a mission, why humility is the greatest trait a leader can have (and certain times when it's not), as well as the necessity of having proper protocols in place to deal with whatever comes your way. We also talk about how Jocko prioritizes his military and family obligations with his love for jiu-jitsu, as well as how to decipher what really matters in life. Finally, we go through the US history with respect to various wars from World War I, all the way forward, and much much more.

In this episode, Kevin Sayer, CEO of Dexcom, discusses the remarkable benefits of a continuous glucose monitor for the diabetes population. Peter shares his own invaluable insights he's learned from wearing a CGM including the impact of sleep and stress on glucose as well as the unmatched power of a CGM to drive behavioral change. Kevin also reveals some of the exciting partnerships and future advancements of their products benefiting not only those with type 1 and 2 diabetes, but also for the growing community of people interested in optimizing health and wellness. We discuss: How they met, and Kevin's path to becoming CEO of Dexcom [7:00]; How CGM technology works, and what makes Dexcom's G6 the best model yet [15:15]; Challenges of working in the US healthcare system and getting CGM insured [21:45]; Developing an even smaller, more user-friendly, and less costly product while maintaining performance and accuracy [33:15]; Next thing on the horizon for type 1 diabetes patients [43:30]; The incredible accuracy of the G6, recommended over-the-counter glucose meters, and the unmatched power of CGM to drive behavioral change [48:15]; Software improvements for type 2 diabetics, and the remarkable benefits of real-time feedback for driving behavioral change [58:15]; Dexcom vs. the competitors, the less invasive options, and the fundamental problems needing to be solved with CGM technologies [1:07:00]; The cost of CGM, why you need a prescription, and when might there be a OTC option? [1:12:00]; Smartwatch integration, bluetooth technology, and exciting collaborations and partnerships [1:22:00]; Future places for CGM: Hospitals, nutrition apps, general health and wellness, and more [1:27:15]; Dexcom's unique company culture [1:34:15]; Parenting advice from Kevin [1:37:30]; Lessons learned through failures and success [1:38:45]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this "Ask Me Anything" (AMA) episode, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter's head of research, asks the questions. If you're listening on a podcast player, you'll be able to hear a preview of the AMA. If you're a subscriber, you can watch or listen to this full episode on our website at the AMA #6 show notes page. PLEASE NOTE: We are currently building a private RSS feed that will allow subscribers to listen uninterrupted on the podcast player of their choice. This will be released shortly. Questions are pulled from the AMA section on the website (peterattiamd.com). Any subscriber is welcome to submit questions. We discuss: Vitamin supplementation: Is it necessary if you eat a balanced diet? [2:00]; Antioxidants: What does current science have to say about antioxidants in food and supplements? [9:00]; How do you break a fast of more than three days? [17:15]; Does a morning black coffee break a fast? In other words, does black coffee raise insulin levels? [22:15]; When intermittent fasting, does the placement of the "feeding window" matter? [25:30]; Is it better to fast before or after a planned food binge (e.g., Thanksgiving)? [28:30]; Fasting protocol: Do you have a specific protocol to recommend? [31:30]; Time management: How do you manage your time between work, family, and your many personal interests? [35:45]; Problem solving: Can you breakdown your process of problem-solving? [46:45]; For those looking to gain a better understanding of biochemistry, pharmacology, etc., do you have any good textbooks or (online) resources to recommend? [49:00]; What are some of your favorite podcasts that you listen to? [51:15]; What is your favorite animal? [54:45]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this episode, Ethan Weiss, Hopkins trained preventative cardiologist at UCSF, discusses two topics that on the surface may seem unrelated which is cardiovascular disease, and the role of growth hormone and IGF in disease. Ethan provides a masterclass in everything from acute coronary syndrome to all of the complex nuances around stent placement, as well as how calcium scores and results from CT angiograms shape his treatment of patients. He also shares how his idea to study the sex differences in blood clotting as it relates to coronary disease lead him to pursue the field of endocrinology, and specifically what he found with respect to the effect of growth hormone and IGF on the liver, the brain, and overall human longevity. We discuss: Mutual love for hockey [7:15]; Ethan's background and interest in cardiology [13:15]; Clinical definitions of a heart attack, clotting, and plaque: What causes the acute event? [24:15]; Defining coronary disease and myocardial infarction: The evolving nomenclature [32:00]; What happens when someone comes to the ER with a STEMI (ST elevation myocardial infarction)? [47:15]; Stents [54:45]; Treatment protocol for both acute and chronic coronary artery disease: History, controversy, and important distinctions [1:06:30]; Using stents to treat stable angina: What we learned from the COURAGE AND ORBITA trials [1:15:30]; The "art" of longevity: The challenge of preventative medicine and understanding risk [1:31:45]; Understanding CAC scores, and CT angiogram results [1:40:15]; How sex differences in clotting and heart disease got Ethan interested in growth hormone and IGF [2:01:00]; Impact of growth hormone on the liver [2:07:00]; Growth hormone and insulin sensitivity [2:18:00]; The role of GH and IGF on chronic disease and cancer [2:23:30]; Will taking growth hormone promote longevity? [2:32:30]; GH and IGF as a treatment for early stage dementia? [2:34:30]; What happens to IGF while fasting and what about fasting improves longevity? [2:35:15]; The importance of becoming scientifically literate and making science more exciting for future generations [2:38:30]; Ethan's new company: Keyto [2:43:45]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

To celebrate the life of the legendary Formula 1 driver Ayrton Senna, 25 years to the day of his tragic death, we are re-releasing this bonus episode. In this episode, Peter and med school colleague (and brilliant psychiatrist) Paul Conti reminisce on their favorite moments in Formula 1 history, their deep admiration for the late Ayrton Senna, and the remarkable careers of their favorite drivers. Paul also helps to illuminate the psychological components that made the luminary drivers great, and the cautionary lessons we can take from their incredible lives. We discuss: Who is Ayrton Senna? [3:47]; How Senna's death changed the sport [9:52]; The 80s & 90s: a remarkable era of Formula 1 [12:57]; Hypothesizing what caused Senna's fatal crash [17:47]; Comparing Stewart and Senna, their incredible bravery, and what lessons we can learn from them [23:32]; Best documentaries on racing, and some of Senna's best moments [31:02]; Gilles Villeneuve, Stefan Bellof, and some of the other greats [39:17]; Why Senna is widely acknowledged as the best of all time [46:17]; Great rivalries and personalities [49:32]; Rendezvous, a high-speed drive through Paris [56:52]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this episode, Robert Sapolsky, Ph.D., discusses the widespread impact of stress on our physical and emotional health as well as the mechanisms by which it can precipitate chronic illness, dementia, depression, and more. He also provides insight into the factors that contribute to the stress response (and our ability to handle it) such as social rank, personality, environment, and genetics. Lastly, we discuss how our behavior is altered in the face of stress and how that not only has a pervasive effect on a personal level, but also on society as a whole in how we interact with each other. We discuss: Background, interest in stress, and Robert's time in Kenya studying baboons [7:00]; Physiology of a stress response, and why it's ingrained in our DNA [14:00]; Individual variation in the response to stress, and how everyone has a different optimal level [24:00]; How social rank and personality differences affect our stress response [30:15]; What's happening in the brain when faced with stressful situations? [39:15]; What makes the human brain different than all other species? [48:15]; Imprinting stress to your kids epigenetically [52:00]; The role of stress on memory and the consequences of hypercortisolemia [57:15]; The impact of subjective socioeconomic status and social media on stress levels and health [1:01:45]; Tips for managing stress in the modern world [1:17:45]; What Robert learned about himself studying the social behavior of baboons [1:29:30]; The multilayered factors behind every human behavior, the context of "good and bad," and exploring the human capacity of the wild extremes of violence and altruism from moment to moment [1:34:30]; PMS: How two women with identical hormone levels can have completely different emotional experiences [1:39:00]; How much of a role do genes play in depression and other emotional states? [1:42:45]; Why is cortisol elevated under sleep deprivation? [1:50:15]; The impact of stress on cancer [1:54:30]; The impact of stress on atherosclerosis, dementia, addiction, and depression [2:01:15]; Impulsiveness, impaired judgement, and lack of empathy in times of stress [2:05:45]; What advice would Robert give his 25-year-old self? [2:12:45]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this "Ask Me Anything" (AMA) episode, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter's head of research, asks the questions. If you're listening on a podcast player, you'll be able to hear a preview of the AMA. If you're a subscriber, you can watch or listen to this full episode on our website at the AMA #5 show note's page. PLEASE NOTE: We are currently building a private RSS feed that will allow subscribers to listen uninterrupted on the podcast player of their choice. This will be released shortly. Questions are pulled from the AMA section on the website (peterattiamd.com). Any subscriber is welcome to submit questions. We discuss: Coronary calcium score: what it means and how to interpret your results [1:15]; How to train for the "centenarian olympics" [18:00]; Explaining the blood glucose response to various types of exercise [35:30]; The Tabata protocol [43:15]; Exercising on a ketogenic (or low-carb) diet: performance, muscle glycogen, adaptation, and more [49:30]; The work of Dr. Gabor Maté and its impact on Peter [54:15]; What's the best book you've read in the past year? [55:45]; What is "pattycakes?" [59:00]; What is the latest and greatest of egg boxing [59:30]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In the final part of this 3 part series, Matthew Walker, professor of neuroscience at UC Berkeley and expert on sleep, discusses the omnipresent effects of insufficient sleep on everything from metabolism, appetite, athletic performance, decision-making, productivity, leadership, mental health, genetics, memory, and more. We also discuss the impact of caffeine and alcohol on sleep quality, the efficacy of sleep aids such as THC and CBD, and much more. We discuss: Sleep and insulin resistance [6:15]; Epigenetic changes with insufficient sleep, and the reversibility of lost sleep [18:00]; Sleep's impact on exercise performance, appetite, and food choices [28:15]; Decision making, workplace production, leadership qualities, physical attractiveness, and more [43:15]; The broken water pipe analogy [49:30]; The negative effect of caffeine, alcohol, and high carb meals on sleep quality [53:30]; The efficacy of THC and CBD as sleep aids [1:05:30]; Sleep and mental health: A two-way street [1:16:45]; How sleep impacts memory, and Matthew's current and upcoming projects [1:24:00]; Sleep's impact on athletes: Looking at Formula One drivers [1:32:45] Translating the science to clinical application [1:57:00]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In part 2 of this 3 part series, Matthew Walker, professor of neuroscience at UC Berkeley and expert on sleep, describes the preponderance of evidence linking poor sleep to cardiovascular disease, cancer, and sexual function. He also details the impact of cortisol on our nervous system contributing to sleep disturbances and insomnia as well as the efficacy and risks associated with the most common sleeping pills. Matthew also describes the sleep needs of teenagers and urgently lays the case that we should reconsider school start times. We also get into the effect of electronics at night, the efficacy of napping, the general impact of modern society on our sleep habits, and what changes we can make to course correct. We discuss: Sleep and cardiovascular disease [6:00]; Fuel partitioning and dieting while sleep deprived [16:45]; Sleep and the reproductive function: testosterone, sperm count, FSH, menstrual cycles, and fertility [19:45]; The biological necessity of sleep, the lack of a "safety net", sleep debt, and ways to course correct sleep problems [23:45]; Fighting cancer and improving immune function with sleep [34:30]; The medical profession: A culture that devalues sleep [47:30]; The sleep needs of children, the travesty of early school start times, electronics at night, and advice for parents [1:04:45]; How exposure to light affects sleep, and how modern society has changed our sleep habits [1:26:15]; Is napping helpful? [1:36:00]; The effect of cortisol levels on sleep [1:41:15]; Are sleeping pills doing more harm than good? [1:52:15]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In part 1 of this 3 part series, Matthew Walker, professor of neuroscience at UC Berkeley and expert on sleep, describes the different stages and cycles of sleep, including what he calls the 4 pillars of sleep, and how they contribute to memory consolidation and numerous important pathways to mental health. We also get into the dangers of chronic sleep deprivation, such as the development of dementia, and the more acute dangers of sleep deprivation like fatal car crashes which are most often caused by drowsy driving. We also discuss the different and important roles of REM vs. non-REM sleep, and the impact that bad sleep habits can have specifically on those sleep stages. We discuss: Matthew's background and interest in sleep [6:03]; Sleep and Alzheimer's disease, and the 4 pillars of sleep [12:18]; Stages of sleep, sleep cycles, and brain waves [41:18]; Memory and sleep, and the risk of insufficient REM sleep [55:48]; Evolutionary reasons to sleep [1:02:03]; The early riser vs. the night owl, and tips for overcoming jet lag [1:10:18]; Is there one type or stage of sleep that is most important? [1:17:33]; The dangers of drowsy driving [1:28:48]; The timeliness of Matthew's book, and how the conversation of sleep has changed over the past several years [1:35:18]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this episode, Chris Masterjohn, entrepreneur, independent researcher, and doctorate in nutrition, elucidates the latest research on the risk and benefits of NAD supplements, and shares his personal intuition on the topic. We also dive deep into choline deficiency and its role in the rising prevalence of nonalcoholic fatty liver disease. From there, Chris enlightens us on the importance of methylation, a simple yet profoundly important biochemical process affecting our physical and mental health. He also describes the variations of the genes MTHFR and COMT, enzymes which play important roles in methylation and which have profound impacts on our well-being. We discuss: Chris's background, falling in love with biochemistry, and decision to pursue research over medicine [7:45]; Choline: what it is, why it is important, and how a deficiency can cause non-alcoholic fatty liver disease [11:45]; NAFLD: increasing prevalence and potential causes [25:00]; TMAO: Should we be worried about the TMAO content in choline and our foods? [39:15]; Types of fatty acids: How they may predispose us to different types of illnesses [53:30]; Why don't we see low VLDL in patients with NAFLD? [59:45]; Understanding flux, and how machine learning may affect medicine in the near future [1:03:15]; NAD: How it works, supplements, sirtuins, and the central role of the liver [1:09:30]; Intravenous NAD [1:33:00]; Oral NR: Is it the optimal way to get more NAD? [1:38:30]; What is the possible harm of taking an NAD precursor? [1:47:15]; The MTHFR gene [1:49:45]; The methylation pathway [1:58:15]; The COMT gene [2:04:30]; Creatine: The uses and benefits and its important role in methylation [2:10:15]; Dietary strategies for MTHFR: choline, creatine, folate, and glycine [2:16:45]; How to mitigate the negative effects of NAD supplements [2:23:45]; A case study of a person with high homocysteine [2:28:00]; What is the level of evidence that you need to take action? [2:32:15]; Does Chris supplement with NAD precursors? And can it improve symptoms of rosacea? [2:35:45]; Decision making in the face of inconclusive data, and trying to disentangle the placebo effect [2:39:00]; What does Chris believe to be true that very few people would agree with him about? [2:43:15]; How to follow Chris's work [2:48:45]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this "Ask Me Anything" (AMA) episode, the first subscriber-only edition, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter's head of research, asks the questions. As a reminder, AMAs are for subscribers only. If you want to subscribe, you can learn more about the benefits at https://peterattiamd.com/subscribe. If you are a subscriber, you can watch or listen to this in full on the show notes portion of our website. If you are listening to this on a podcast player, you will hear a sneak peek of this AMA and then will have to finish listening or watching on the website. All questions are pulled from the AMA section on the website (https://peterattiamd.com/ask-me-anything/). Any subscriber is welcome to submit questions. We discuss: Blue light blockers and how they improve sleep [1:30]; How to minimize jet lag and sleep disruption while traveling [6:45]; How to treat symptoms of PMS, the female hormone cycle, testosterone in women, and estrogen in men [15:45]; Autophagy: what it is, why it matters, and how can we enhance it [26:15]; The two-minute drill (and a bonus Patriots and Tom Brady tangent) [41:15]; Has Peter thought about having CME accredited content for people in the medical field? [44:15]; How does one find good doctors that are somewhat up to date on the latest research, primary care, etc.? [45:45]; What values would Peter be interested in monitoring continuously if the tech existed? [47:15]; How to annoy Peter [49:15]; If I'm interested in longevity, should I do a Ph.D. or M.D.? [50:00]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this episode, Jeremy Schaap, preeminent journalist at ESPN, discusses two of the most incredible upsets in boxing history, both of which Jeremy has expertly covered during his illustrious career, most recently culminating in the 30 for 30 special, 42 to 1. We also discuss his infamous Bobby Knight interview, his coverage of the doping scandals in baseball and cycling, as well as the pressures of following in his father's enormous footsteps who taught him the importance of fairness in journalism. Additionally, we discuss the deeper meaning of sports, what it teaches us, and how he uses sports as a platform to bring light to greater societal issues. We discuss: Jeremy and Peter's shared obsession with boxing history [5:15]; Cinderella Man: The incredible upset of Max Baer by James Braddock, and the rise of the great Joe Louis [9:00]; 42 to 1: Buster Douglas beats Mike Tyson for one of the most unlikely upsets in the history of sports [23:30]; Contrasting fighting styles from "destroyers" to "artists", and comparing the auras of the all-time greats [36:30]; Mike Tyson's take on the Douglas fight, what went wrong for Buster Douglas following his victory, and other incredible upsets in sports history [45:30]; Ranking the greatest boxers since the 1960s [54:00]; Jeremy's famous Bobby Knight interview: A career defining moment [57:00]; The pressures of following his father's career path, and what it means to be a fair journalist [1:01:30]; The meaning of sports: how it brings us together and gives us a platform for bigger discussions [1:11:00]; Jeremy's biggest regret in reporting, the 1998 home run chase, and the doping scandals of baseball and cycling [1:17:30]; The biggest and most underreported stories in sports [1:26:45]; Best 30 for 30 episodes: Jeremy and Peter pick their favorites [1:31:30]; Baseball: Steroids and the hall of fame [1:34:30]; Final thoughts on what makes sports so special [1:37:45]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this episode, Alan Bauman, certified hair transplantation surgeon and hair restoration expert, discusses both male and female pattern hair loss, the science behind what drives it, and what that tells us about prevention and restoration. Having treated over 20,000 patients, Alan shares his invaluable insights into what works and what doesn't in terms of the non-surgical treatment options. We also go into great detail about the more invasive approaches like PRP, and of course, hair transplantation, a procedure which Alan has refined over the years into a proprietary method that seems to produce unbelievable results. Additionally, Alan provides tips for maintaining scalp health, which is vital for hair growth, as well as the importance of choosing a hair specialist who has the tools, expertise, and patience to develop a compassionate and encompassing approach to hair restoration. We discuss: Alan's unique path, and how he became interested in hair transplantation [7:15]; The prevalence of hair loss, types of hair loss, and the different patterns in men vs. women [15:45]; The role of genetics in hair loss, and when does it start [19:00]; Female hair loss: the role of hormones, pregnancy related hair loss, and what it means to have thinning and shedding [22:30]; Primary drivers of male hair loss, finasteride as a treatment, and the potential side effects [26:15]; Common treatments - Proscar, Propecia, Rogaine, and more - how they all came about and what you need to know [29:45]; Primary drivers of female hair loss, potential treatments, and the different types of hair follicles [33:15]; What are some of the unproven/snake oil methods of hair treatments being pushed to the public? [37:15]; Preventative steps to take if you're worried about future hair loss [42:00]; Medications that may negatively affect hair quality [45:30]; The importance of seeing a hair specialist [47:15]; Impact of scalp health and inflammation on hair growth, how to pick and apply shampoo and conditioner, and how to avoid and treat hair breakage [50:15]; Treatment options - finasteride, minoxidil, laser caps - how they work and what you need to know [57:15]; PRP treatment: How it works, details of the procedure, and Alan's proprietary protocol [1:11:45]; The hair transplant procedure [1:29:30]; Risks involved with a hair transplant procedure [1:44:00]; Is a donor hair susceptible to the forces of the implant site that caused the hair loss? Can a hair follicle grow anywhere on the body? [1:47:45]; Age appropriate procedures, how far the field has come, and why Alan loves his work [1:51:45]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this episode, Avrum Bluming, hematologist, medical oncologist, and emeritus clinical professor at USC and Carol Tavris, social psychologist and author of Mistakes Were Made (But Not By Me), discuss their collaboration on their recent book, Estrogen Matters. Their book takes on the very polarizing and confusing topic of hormone replacement therapy for women suffering with symptoms of menopause. In many ways, the story and history of HRT is in striking parallel to the bad science that led up to the dietary guidelines being set forth in 1980. Carol and Avrum make a compelling case that most women benefit greatly from being on postmenopausal hormone replacement therapy, and can do so without increasing their risk of breast cancer. We also cover the history of HRT, the impact of the Women's Health Initiative, and take a deep dive into each of the clinical conditions for which HRT should be considered, such as cardiovascular disease, neurodegenerative disease, and osteoporosis, to name a few. We discuss: The background of Carol and Avrum, and the impetus for writing Estrogen Matters [8:45]; The sad early history of hormone replacement therapy, treatments for prostate and breast cancer, and the difference between the treatment of women vs. men [14:00]; What hormones do, and why they drop off rapidly in women compared to gradually in men [20:15]; Mistreatment of women leading to great skepticism [23:45]; Breast cancer vs heart disease: Comparing the incidence and mortality in women [27:00]; Case studies of women suffering symptoms of menopause [30:00]; What are Carol and Avrum's true motivations in this endeavor? [32:45]; The changing perceptions of HRT, the impact of the Women's Health Initiative (WHI), and the problems with the WHI [37:45]; Is this one big conspiracy? The uncanny resemblance of the story of HRT and how the dietary guidelines were created [46:00]; Why people (falsely) think estrogen causes a 25% increase in breast cancer, and a lesson in absolute vs. relative risk [57:15]; The truth about progesterone and cancer risk, and the best types of estrogen and progesterone to be taking [1:09:00]; The Women's Health Initiative: the reported findings, walking back their bold claims, and their hesitance to admit they were wrong [1:17:45]; Brain benefits of HRT, Alzheimer's disease in women, and estrogen as a preventative treatment for AD [1:22:45]; The impact of HRT on heart disease, the ideal time to start HRT, and the risks associated with HRT [1:26:45]; The benefits of estrogen on bone health, and the incidence and mortality of hip fractures [1:33:15]; Colon cancer: Can HRT reduce the risk of colon cancer? [1:38:15]; Diabetes: Can HRT reduce the risk of developing diabetes? [1:40:30]; The downsides of hormone replacement therapy (HRT) [1:41:30]; How to approach your doctor who may already have a very strong point of view about HRT [1:42:15]; What kind of research needs to be done to answer the remaining questions about the benefits and risks of HRT? [1:48:30]; Cancer: Our evolving understanding and the future of treatment [1:59:15]; Welcoming the critics: Avrum and Carol want to start a conversation [2:02:00]; Are there racial differences in benefits and risks with HRT? [2:04:15]; The reactions to Estrogen Matters, and why it is a must read [2:09:15]; HRT after a diagnosis of breast cancer [2:13:45]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this episode, Jake Kushner, pediatric endocrinologist specializing in helping people with type 1 diabetes, discusses the best strategies to live and thrive with T1D, especially as it relates to diet and exercise. We also discuss why many patients who control their blood sugar with high amounts of exogenous insulin are at a substantially higher risk than people who can control their blood sugar at lower levels of insulin. This concept has great implications for non-diabetics as well considering the increasing prevalence of diseases related to insulin resistance. We also cover some of the basics, the history, the increasing prevalence of type 1 diabetes, and more importantly, what we can do to help kids with this disease, and their families. We discuss: How Jake became interested in type 1 diabetes [5:30]; The pathophysiology of type 1 diabetes, the increase in prevalence, and the role of beta cells [17:00]; The role of body weight and BMI in the risk of developing T1D [27:00]; Genetics of T1D and the risk of inheritance [32:00]; Hemoglobin A1c [36:15]; Insulin: the amazing story of its discovery, its effect on cellular metabolism and IGF-1, and why the hell it's so expensive [39:15]; Diabetes Control and Complication Trial: blood glucose and the complications associated with diabetes [54:45]; Cognitive impairment, epigenetic changes, and other dangers associated with high, peak blood glucose, and big swings in blood glucose levels [1:09:15]; Depression, anxiety, and other challenges of living with T1D [1:15:30]; Jake's realization that the current standard of care of T1D is inadequate [1:26:15]; Managing diabetes with exercise [1:30:15]; The Bernstein method, and protein's impact on glucose and insulin [1:36:15]; Jake radically changes his approach to treating patients [1:45:00]; What other tools are there for controlling T1D? [1:49:45]; Is the ketogenic diet appropriate for those with T1D? [1:52:45]; The most important lessons that can be applied by the non-diabetic population [1:59:00]; The two dream measurements Peter wishes were available [2:04:00]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this episode, Tom Catena, a missionary physician who runs Mother of Mercy Hospital in the Nuba Mountains in Sudan, describes some of his extraordinary work as the only doctor in a remote, war-torn region of Africa. In terms of individual lives saved, you could argue that there is no other person on the front lines doing more than Tom. Additionally, we explore the manner in which the Nuba people die, which is in striking contrast the ubiquity of chronic disease and self-harm in the west, despite the extreme poverty and unimaginable suffering experienced by the Nuba people. Lastly, we discuss the lessons to be gleaned from the Nuba people, who despite their suffering, live so harmoniously, happily, and resiliently. To support Tom's mission please visit www.amhf.us. We discuss: Background, medical training, and early days of missionary work in Africa [9:00]; Tom arrives at Mother of Mercy Hospital in the Nuba Mountains of Sudan, civil war breaks out, and his staff evacuates [15:45]; Learning surgery on the job and earning the trust of the community [40:45]; The amazing people of Nuba, and why Nuba feels like home to Tom [51:30]; NY Times article about Tom's work, and Tom's new venture on the board of Aurora Prize Foundation bringing awareness and funding to other missionaries doing great work [1:03:30]; Tom's mind-blowing ability to deal with chaos while seeing hundreds of patients per day [1:15:45]; The most afraid Tom has ever been, and how he copes with the emotional trauma of his daily experiences [1:23:30]; The basic tools, technologies, and medicines that Tom is lacking that could save many lives [1:33:30]; The logistical challenge of helping Tom's hospital, and what Tom really needs [1:39:15]; Diseases in the adult population [1:42:30]; Living without possessions, finding meaning, and being a missionary [1:59:30]; Sense of purpose, happiness, and suicide: Contrasting the US with Nuba [2:11:00]; Other than donations, is there a way people can help Tom and other similar causes? [2:19:15]; The food in Nuba [2:22:30]; Tom's annual bout of malaria [2:27:30]; Patients that Tom will never forget [2:29:45]; Resources for people wanting to get involved in helping Tom's work [2:34:45]; Peter tells a story that defines Tom [2:36:00]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this episode, Ted Schaeffer, Professor and Chair of the Department of Urology at Northwestern (youngest chairman in the country), presents the roadmap for the best way to screen for, and treat, prostate cancer. We also get into the "mass screening" controversy and all the risks involved with treatment. In addition, we discuss our evolving understanding of cancer and the most exciting areas of research to come. We discuss: Ted's unique path to get his PhD [5:15]; The exciting transition in science during Ted's PhD in the 1990s [15:30]; Ted's advice to MD-PhD students, and why he choose urology and Johns Hopkins [23:45]; History of prostate surgery, and Pat Walsh's legendary work in prostate cancer [36:15]; Prostate surgery and the risks involved with treatment [53:00]; Screening for prostate cancer [58:00]; The "mass screening" controversy [1:12:45]; Biopsies and MRI: important things to know [1:25:30]; Why urology such a great field of medicine, and why Peter wants a goat [1:34:45]; Ted's work with Ben Stiller [1:39:00]; Gleason grading system [1:43:45]; Testosterone, DHT and the prostate cancer controversy [1:53:15]; The metabolism of the prostate [2:03:00]; The most exciting areas of research in prostate cancer [2:08:00]; Benign issues involving the prostate: pelvic pain, infections and treatments [2:11:15]; Video of Ted's surgeries, the latest technology, and males contraceptive options [2:18:00]; Watches and cars [2:23:30]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this episode, Francisco Gonzalez-Lima, a Professor of Neuroscience and Pharmacology & Toxicology, explains the vascular hypothesis of Alzheimer's disease which says the central problem is a progressive neuronal energy crisis of impaired blood flow to the brain and impaired mitochondrial respiration. He walks us through the ways we can intervene in this process and also shares details of the exciting future of Alzheimer's treatment and prevention. We discuss: Background and interest in the brain [5:15]; The unique nature of the human brain [9:15]; Why we've made so little progress in Alzheimer's research [23:00]; The amyloid beta hypothesis [28:30]; Hypometabolism in the brain leading to cognitive decline [39:30]; Early signs of AD, and deciphering between age-related decline versus something pathologic [47:45]; The vascular hypothesis of Alzheimer's disease [54:00]; The relationship between mitochondria, cytochrome c oxidase, and Alzheimer's disease [1:08:00]; Chronic inhibition of cytochrome c oxidase leads to chronic neurodegenerative disease [1:22:45]; Major risk factors for AD, head trauma, and other forms of dementia [1:33:45]; Methylene blue for treating and preventing neurodegeneration [1:38:15]; Current standard of care for AD, and the reasons for a lack of advancement [2:01:45]; Near infrared light as a targeted treatment for cognitive decline [2:05:30]; The ketogenic diet as a treatment and preventative measure [2:13:15]; Exciting future research coming from Francisco [2:23:00]; Methylene blue for traumatic brain injuries [2:25:15]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.