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The Peter Attia Drive

The Peter Attia Drive

Expert insight on health, performance, longevity, critical thinking, and pursuing excellence. Dr. Peter Attia (Stanford/Hopkins/NIH-trained MD) talks with leaders in their fields.

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#186 - Patrick Radden Keefe: The opioid crisis?origin, guilty parties, and the difficult path forward

Patrick Radden Keefe is an award-winning staff writer at The New Yorker and the bestselling author of Empire of Pain: The Secret History of the Sackler Dynasty. In this episode, Patrick tells the story of the Sackler family and Purdue Pharma - makers of the pain management drug OxyContin, providing the backdrop for the ensuing opioid epidemic and public health crisis. He reveals the implicit and sometimes explicit corruption of all parties involved in the development, approval, and marketing of OxyContin, leading to a cascade of unintended consequences including addiction and death. He explains the unfortunate lack of accountability for the current crisis, as well as what it all means for those with legitimate pain management needs. Finally, he examines the difficult path ahead towards finding a solution.

We discuss:

Patrick?s investigation into distribution and use of drugs in our society [3:55];
The scale of the opioid crisis [9:15];
The Sackler brothers: family life, career in the pharmaceutical industry, and role in the current crisis [11:45];
Purdue Pharma: origins, early years, and move towards pain management drugs [17:30];
The development of OxyContin: its conception, marketing, and the controversy around the FDA approval process [25:30];
Early reports of OxyContin addiction and unintended consequences and how Purdue Pharma sidestepped responsibility [40:45];
The many paths to addiction and abuse of OxyContin and the ensuing downfall of Purdue Pharma [47:15];
Peter?s personal experience with OxyContin [57:00];
Pain?the ?fifth vital sign,? how doctors are trained in pain management, and the influence of money [1:08:00];
Other players that helped facilitate the eventual opioid crisis [1:16:15];
Lack of accountability following the investigation and prosecution of Purdue and the Sackler family [1:23:30];
Legacy of the Sackler family and their disconnect from reality [1:34:45];
Patrick?s views on the regulation and use of pain management drugs [1:42:15];
The difficult path forward [1:44:45]; and
More. Learn more: https://peterattiamd.com/
Show notes page for this episode: https://peterattiamd.com/PatrickRaddenKeefe 
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2021-12-06
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#185 - Allan Sniderman, M.D.: Cardiovascular disease and why we should change the way we assess risk

Allan Sniderman is a highly acclaimed Professor of Cardiology and Medicine at McGill University and a foremost expert in cardiovascular disease (CVD). In this episode, Allan explains the many risk factors used to predict atherosclerosis, including triglycerides, cholesterol, and lipoproteins, and he makes the case for apoB as a superior metric that is currently being underutilized. Allan expresses his frustration with the current scientific climate and its emphasis on consensus and unanimity over encouraging multiple viewpoints, thus holding back the advancement of metrics like apoB for assessing CVD risk, treatment, and prevention strategies. Finally, Allan illuminates his research that led to his 30-year causal model of risk and explains the potentially life-saving advantages of early intervention for the prevention of future disease.

We discuss:

Problems with the current 10-year risk assessment of cardiovascular disease (CVD) and the implications for prevention [4:30];
A primer on cholesterol, apoB, and plasma lipoproteins [16:30];
Pathophysiology of CVD and the impact of particle cholesterol concentration vs. number of particles [23:45];
Limitations of standard blood panels [29:00];
Remnant type III hyperlipoproteinemia?high cholesterol, low Apo B, high triglyceride [32:15];
Using apoB to estimate risk of CVD [37:30];
How Mendelian randomization is bolstering the case for ApoB as the superior metric for risk prediction [40:45];
Hypertension and CVD risk [49:15];
Factors influencing the decision to begin preventative intervention for CVD [58:30];
Using the coronary artery calcium (CAC) score as a predictive tool [1:03:15];
The challenge of motivating individuals to take early interventions [1:12:30];
How medical advancement is hindered by the lack of critical thinking once a ?consensus? is reached [1:15:15];
PSK9 inhibitors and familial hypercholesterolemia: two examples of complex topics with differing interpretations of the science [1:20:45];
Defining risk and uncertainty in the guidelines [1:26:00];
Making clinical decisions in the face of uncertainty [1:31:00];
How the emphasis on consensus and unanimity has become a crucial weakness for science and medicine [1:35:45];
Factors holding back the advancement of apoB for assessing CVD risk, treatment, and prevention strategies [1:41:45];
Advantages of a 30-year risk assessment and early intervention [1:50:30];
More. Learn more: https://peterattiamd.com/
Show notes page for this episode: https://peterattiamd.com/AllanSniderman 
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2021-11-29
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Rick Johnson, M.D.: Metabolic Effects of Fructose (Ep. #87 Rebroadcast)

Today?s episode of The Drive is a rebroadcast of the conversation with Rick Johnson (originally released January 6th, 2020). This episode was one of the most popular discussions to-date and is a prelude to an upcoming follow-up discussion which will be coming out in February 2022 along with the release of Rick?s new book.

In this episode, Rick Johnson, professor of nephrology at the University of Colorado, explains how his research into the causes of blood pressure resulted in a change of research direction to focus more on how fructose has such profound metabolic effects. Rick begins by talking about the relationship between salt and high blood pressure, then provides a masterclass into uric acid, and then expertly reveals the mechanisms and pathways by which sugar (specifically fructose) can profoundly impact metabolic health. From there, he explains how he applies this information to real life patients as well as touches on some of the most promising ideas around pharmacotherapy that are being developed in response to the epidemics of fatty liver, insulin resistance, diabetes, and obesity. Furthermore, Rick gives his take on artificial sweeteners compared to real sugar, discusses cancer?s affinity for fructose, and much more.

We discuss:

The connection between blood pressure and fructose that shifted Rick?s professional focus [3:00];
The relationship between salt and blood pressure (and the role of sugar) [4:45];
Defining fructose, glucose, and sugar [18:30];
An ancient mutation in apes that explains why humans turn fructose into fat so easily [22:00];
The problems with elevated uric acid levels, and what it tells us about how sugar causes disease [30:30];
How sugar causes obesity?explaining the difference in glucose vs. fructose metabolism and the critical pathway induced by fructose [39:00];
Why drinking sugar is worse than eating it [49:00];
Unique ability of sugar to drive oxidative stress to the mitochondria, insulin resistance, and diabetes [53:00];
Why cancer loves fructose [59:20];
The many areas of the body that can use fructose [1:04:00];
Fructokinase inhibitors?a potential blockbuster? [1:06:15];
Treating high uric acid levels?Rick?s approach with patients [1:09:00];
Salt intake?what advice does Rick give his patients? [1:15:30];
How excess glucose (i.e., high carb diets) can cause problems even in the absence of fructose [1:20:00];
Artificial sweeteners vs. real sugar?which is better? [1:28:15];
Umami, MSG, alcohol, beer?do these have a role in metabolic illness? [1:32:45];
Fructose consumption?Is any amount acceptable? Is fruit okay? Where does Rick draw a hard line? [1:37:45]
How does Rick manage the sugar intake of his young kids? [1:42:00]; and
More.
Learn more: https://peterattiamd.com/
Show notes page for this episode: https://peterattiamd.com/rickjohnson/ 
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2021-11-22
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#184 - AMA #29: GLP-1 Agonists?The Future of Treating Obesity?

In this ?Ask Me Anything? (AMA) episode, Peter and Bob discuss all things related to GLP-1 agonists?a class of drugs that are gaining popularity for the treatment of obesity. They cover the discovery of these peptides, their physiology, and what it is they do in their natural state. Next, Peter and Bob break down a recently published study which showed remarkable results for weight loss and other metabolic parameters using a once-weekly injection of the GLP-1 agonist drug semaglutide, also known as Ozempic, in overweight and obese patients. Finally, they compare results from the semaglutide study to results from various lifestyle interventions and give their take on the potential future of GLP-1 agonists.

If you?re not a subscriber and listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #29 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Remarkable results of a recent study in overweight adults [2:15];
Key background on insulin, glucagon and the incretin effect [4:00];
What is GLP-1 and how does it work? [16:30];
2021 semaglutide study: remarkable results, side effects, and open questions [30:00];
Semaglutide vs. lifestyle interventions: comparing results with semaglutide vs. lifestyle interventions alone [44:00];
Closing thoughts and open questions on the therapeutic potential of semaglutide [47:30]; and
More Learn more: https://peterattiamd.com/
Show notes page for this episode: https://peterattiamd.com/ama29/ 
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2021-11-15
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#183 - James Clear: Building & changing habits

James Clear is the author of the New York Times bestseller Atomic Habits. His extensive research into human behavior has helped him identify key components of habit formation and develop the ?Four Laws of Behavioral Change.? In this episode, James provides insights into how both good and bad habits are formed, including the influence of genetics, environment, social circles, and more. He points to changes one can make to cultivate more perseverance and discipline and describes the profound impact habits can have when tying them into one?s self-identity. Finally, James breaks down his ?Four Laws of Behavioral Change? and how to use them to create new habits, undo bad habits, and make meaningful changes in one?s life.

We discuss:

Why James became deeply interested in habits [1:45];
Viewing habits through an evolutionary lens [6:00];
The power of immediate feedback for behavior change, and why we tend to repeat bad habits [9:15];
The role of genetics and innate predispositions in determining one?s work ethic and success in a given discipline [14:30];
How finding one?s passion can cultivate perseverance and discipline [23:15];
Advantages of creating systems and not just setting goals [29:15];
The power of habits combined with self-identity to induce change [36:30];
How a big environmental change or life event can bring on radical behavioral change [50:30];
The influence of one?s social environment on their habits [54:15];
How and why habits are formed [1:00:30];
How to make or break a habit with the ?Four Laws of Behavior Change? [1:09:30];
Practical tips for successful behavioral change?the best strategies when starting out [1:16:15];
Self-forgiveness and getting back on track immediately after slipping up [1:30:30];
Law #1: Make it obvious?strategies for identifying and creating cues to make and break habits [1:39:45];
Law #2: Make it attractive?ways to make a new behavior more attractive [1:47:45];
Law #3: Make it easy?the 2-minute rule [1:58:45];
Law #4: Make it satisfying?rewards and reinforcement [2:03:30];
Advice for helping others to make behavioral changes [2:06:00];
More. Learn more: https://peterattiamd.com/
Show notes page for this episode: https://peterattiamd.com/jamesclear/ 
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2021-11-08
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#182 - David Nutt: Psychedelics & Recreational Drugs

David Nutt is a psychiatrist and a neuroscientist at Downing College, Cambridge.  His research focuses on illicit drugs?their harm, classification, and potential for therapeutic use in psychiatry. In this episode, David discusses his framework for assessing the potential harm caused by common recreational drugs and explains how they are regulated, which is oftentimes misaligned with actual risk. He describes in detail the neurobiology, mechanisms of action, and addiction potential of alcohol, opiates, cocaine, and methamphetamine and contrasts those with psychedelics, which have been given a similar regulatory classification despite their relatively low risk of harm and their numerous potential therapeutic uses. Additionally, David explains the promise of psychedelics like ketamine, MDMA, and psilocybin for treating drug addiction and depression and discusses how political pressures have created roadblocks to future necessary research.

We discuss:

David?s early interest in the brain and experience in psychiatry [2:45];
David?s brief work on government drug policy in the UK [10:15];
A scale for rating the relative harm of certain drugs [13:45];
The contrast in regulation between cannabis vs. alcohol and why research on potential benefits of cannabis is lacking [19:15];
The opiate crisis and rise of fentanyl: the cause and potential solution [25:00];
The science of addiction and the potential use of psychedelics for treating drug addiction [35:00];
Cocaine: mechanisms of action and risks [41:45];
Methamphetamine and crystal meth: mechanisms of action and neurotoxicity [48:15];
How psychedelics came to be classified as schedule I drugs despite their numerous therapeutic uses [52:45];
The history of MDMA and the bad science and political forces leading to its demonization [1:08:45];
History of ketamine, medical use of esketamine, and the waning effects of psychedelics with increasing usage [1:13:30];
Psilocybin for depression: David?s promising research and the roadblocks to more robust experiments [1:20:15];
More. Learn more: https://peterattiamd.com/
Show notes page for this episode: https://peterattiamd.com/davidnutt 
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2021-11-01
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#181 - Robert Gatenby, M.D.: Viewing cancer through an evolutionary lens and why this offers a radically different approach to treatment

Robert (Bob) Gatenby is a radiologist who specializes in exploring theoretical and experimental models of evolutionary dynamics in cancer and cancer drug resistance. He has developed an adaptive therapy approach for treating cancer which has shown promise in improving survival times with less cumulative drug use. In this episode, Bob explains what brought him into medicine, his search for organizing principles from which to understand cancer, and the mathematical modeling of other complex systems that led him to model the dynamics of tumor cell changes in cancer. He discusses his pilot clinical trial treating metastatic prostate cancer, in which he used an evolutionary game theory model to analyze patient-specific tumor dynamics and determine the on/off cycling of treatment. He describes how altering chemotherapy to maximize the fitness ratio between drug-sensitive and drug-resistant cancer cells can increase patient survival and explains how treatment of metastatic cancer may be improved using adaptive therapy and strategic sequencing of different chemotherapy drugs.

We discuss:

Bob?s unlikely path to medicine and disappointment with his medical school experience [1:45];
Rethinking the approach to cancer: using first principles and applying mathematical models [12:15];
Relating predator-prey models to cancer [26:30];
Insights into cancer gathered from ecological models of pests and pesticides [32:15];
Bob?s pilot clinical trial: the advantages of adaptive therapy compared to standard prostate cancer treatment [41:45];
New avenues of cancer therapy: utilizing drug-sensitive cancer cells to control drug-resistant cancer cells [48:15];
The vulnerability of small populations of cancer cells and the problem with a ?single strike? treatment approach [56:00];
Using a sequence of therapies to make cancer cells more susceptible to targeted treatment [1:05:00];
How immunotherapy fits into the cancer treatment toolkit [1:15:30];
Why cancer spreads, where it metastasizes, and the source-sync trade off [1:20:15];
Defining Eco- and Evo-indices and how they can be used to make better clinical decisions [1:29:45];
Advantages of early screening for cancer [1:40:15];
Bob?s goals for follow-ups after the success of his prostate cancer trial [1:42:15];
Treatment options for cancer patients who have ?failed therapy? [1:51:15];
More.

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Show notes page for this episode: https://peterattiamd.com/RobertGatenby

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2021-10-25
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#180 - AMA #28: All things testosterone and testosterone replacement therapy

In this ?Ask Me Anything? (AMA) episode, Peter and Bob discuss all things related to testosterone: what happens when testosterone levels are low, and the potential benefits and risks of testosterone replacement therapy (TRT). They explain the physiology of testosterone, how it works, and how its level changes over the course of a person's life. They have a detailed discussion about existing literature, which reveals vast potential structural, functional, and metabolic benefits of testosterone replacement therapy. They also take a very close look at potential risks of this therapy, with a focus on the controversial effects on cardiovascular disease and prostate cancer.

If you?re not a subscriber and listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #28 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

A primer on the hormone testosterone and how it influences gene expression [3:30];
How the body naturally regulates testosterone levels [11:30];
The defining threshold for "low testosterone," how low T impacts men, and why free testosterone is the most important metric [16:15];
When it makes sense to treat low testosterone [26:00];
The structural and metabolic benefits of testosterone replacement therapy [29:15];
Body composition changes with TRT [45:30];
Changes in bone mineral density with TRT [48:15];
The metabolic impact of TRT: glucose, insulin, triglycerides, and more [52:30];
A study investigating testosterone replacement therapy for prevention or reversal of type 2 diabetes [59:30];
The impact of TRT on metabolic parameters and body composition?A study comparing results from continuous vs. interrupted treatment [1:07:15] The controversy over TRT and cardiovascular disease [1:21:45];
Two flawed studies that shaped perceptions of risks associated with TRT [1:44:15];
The controversy over TRT and prostate cancer [1:56:45];
Other potential risks with testosterone replacement therapy [2:02:15]; and
More Learn more: https://peterattiamd.com/
Show notes page for this episode: https://peterattiamd.com/ama28/ 
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2021-10-18
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#179 - Jeremy Loenneke, Ph.D.: The science of blood flow restriction?benefits, uses, and what it teaches us about the relationship between muscle size and strength

Jeremy Loenneke has a Ph.D. in exercise physiology, a Master?s in nutrition and exercise, and is currently the director of the Kevser Ermin Applied Physiology Laboratory at the University of Mississippi, where he focuses his research on skeletal muscle adaptations to exercise in combination with blood flow restriction (BFR). In this episode, Jeremy explains the science of BFR and the mechanisms by which BFR training can produce hypertrophy using low loads. Here, he reviews anatomy and terminology of muscle structure and discusses the evidence that increasing muscular strength may not be dependent on increasing muscle size. Additionally, Jeremy goes into depth on how one might take advantage of BFR training, including practical applications for athletes and average people, as well as the situations for which BFR training would be most advantageous.

We discuss:

Jeremy?s interest in exercise and weightlifting and his scientific training [3:30];
The microstructure and physiology of muscle [8:00];
Definitions of fast-twitch and slow-twitch muscle fibers [12:45];
Comparison of strength vs. hypertrophy [21:30];
Blood flow restriction training and the origins of the Kaatsu system [28:30];
The details and metrics related to exercise under blood flow restriction [44:45];
Considerations when training with blood flow restriction: loading, pace, rest, and risks [53:00];
Blood flow restriction studies and the relationship between muscle size and muscle strength [1:04:15];
Evidence that increasing muscular strength is not dependent on increasing the size of the muscle [1:16:30];
Practical applications of blood flow restriction training for athletes and average people [1:27:30];
Situations in which blood flow restriction training is most advantageous [1:35:30];
The mechanisms by which blood flow restriction training can produce so much hypertrophy at such low loads [1:39:45];
Applications of ?passive? blood flow restriction training [1:47:15];
What experiments would Jeremy do if he had unlimited resources? [1:51:45];
More.

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Show notes page for this episode: https://peterattiamd.com/JeremyLoenneke 

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2021-10-11
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#178 - Lance Armstrong: The rise, fall, and growth of a cycling legend

Lance Armstrong is a legendary figure in professional cycling having won seven consecutive Tour de France titles but also a controversial figure facing scrutiny for the use of performance enhancing drugs. In this episode, Lance takes us through his meteoric rise to one of the most famous athletes in the world and his equally accelerated fall from grace. Lance describes how he persevered through his brutal diagnosis of testicular cancer before rattling off a historic run of seven consecutive Tour de France titles all while facing tremendous scrutiny for his alleged use of performance enhancing drugs such as EPO and cortisone. Lance opens up about his decision to come clean about his use of performance enhancing drugs, the remorse for how he treated other people during that time in his life, and the personal growth that?s helped him emerge on the other end of that. Finally, Lance recounts some of favorite stories from his cycling career, reflects on his legacy, and explains how he stays fit at age 50.

We discuss:

What everyone wants to know?yes and no questions [2:15];
Lance?s childhood and beginnings of a great athlete [4:15];
Lance?s realization that he had a knack for racing after his first pro race at age 15 [13:00];
The move to cycling full time and a desire to compete in the Olympics [16:30];
Metrics tracked early in Lance?s career and his time with Motorola team [20:00];
The grueling nature of the Tour de France and the beginnings of serious drug usage in cycling [27:00];
The impact of EPO on cycling performance [35:15];
Testicular cancer diagnosis?denial, torturous symptoms, and treatment [38:15]
Livestrong is born [50:45];
Return to cycling post-cancer and a crossroad in Lance?s career [53:45]
Lance?s rise to prominence in the late 90s and the growing use of EPO in the sport [1:00:00];
Racing in the early 2000?s, blood transfusions, and rivalry with Jan Ulrich [1:12:00];
Retirement in 2005 and a comeback in 2009 [1:22:45];
Lance?s decision to come clean and tell the truth [1:27:30];
Growth through downfall: learning from his mistakes and helping others after their own fall from grace [1:33:00];
Moving forward: Living his life, reflecting on his legacy, the state of Livestrong [1:42:30];
Turning back the clock: Advice Lance would give to his 15 year-old self [1:46:45];
Keeping fit at age 50 [1:51:00];
More.

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2021-10-04
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#177 - Steven Rosenberg, M.D., Ph.D.: The development of cancer immunotherapy and its promise for treating advanced cancers

Steve Rosenberg is the Chief of Surgery at the National Cancer Institute, a position he has held continuously for the past 47 years. Steve is a pioneer in the field of immunotherapies for cancer and a recipient of nearly every major award in science. In this episode, Steve discusses his inspiration for devoting his career to cancer research and describes his keen observation of two cases of spontaneous cancer remission, driving him to learn how to harness the immune system to treat cancer. Steve?s personal story essentially serves as a roadmap for the field of immunotherapy, from the very non-specific therapies such as interleukin-2, the discovery of tumor-infiltrating lymphocytes, checkpoint inhibitors, CAR T-cells, and adoptive cell therapy. Perhaps most importantly, Steve expresses his optimism for what lies ahead, especially in the face of some of the more recent discoveries with respect to tumor antigenicity. Finally, Steve discusses the human side of cancer which helps him to never lose sight of why he chose to become a physician.

We discuss:

Steve?s childhood and inspiration to become a physician and medical researcher [3:15];
Patients that influenced Steve?s thinking about cancer and altered the course of his career [13:15];
The discovery of antigen presentation, Steve?s first job, and why he knew he wanted to study cancer [19:30];
Cancer treatment in the early 1970?s and Steve?s intuition to utilize lymphocytes [26:45];
Cancer cells versus non-cancer cells, and why metastatic cancer is so deadly [31:45];
The problem with chemotherapy and promise of immunotherapy [38:30];
How the immune system works and why it seems to allow cancer to proliferate [43:15];
Steve discovers how to use interleukin-2 to mediate cancer regression [52:00];
The immunogenic nature of certain cancers and the role of mutations in cancer [1:03:45];
The improbable story of how CAR T cell therapy was developed [1:16:30];
The discovery of tumor infiltrating lymphocytes (TIL) and engineering of T cells to recognize specific antigens [1:28:00];
Steve?s experience treating President Ronald Reagan?s colon cancer [1:36:00];
Why Steve has turned down many tempting job offers to focus on his research at the National Cancer Institute [1:41:00];
The role of checkpoint inhibitors in cancer therapy and the promise of adoptive cell therapy [1:43:00];
Optimism for using immunotherapy to cure all cancers [1:48:00];
The human side of cancer and the important lessons Peter learned from working with Steve [1:52:15]; and
More

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2021-09-27
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#176 - AMA #27: The importance of muscle mass, strength, and cardiorespiratory fitness for longevity

In this ?Ask Me Anything? (AMA) episode, Peter and Bob discuss the longevity benefits from greater cardiorespiratory fitness (CRF) and greater muscle mass and strength. Conversely, they dive deep into the literature showing a rapid increase in morbidity and mortality risk as fitness levels decline with age. They also try to tease out the relative contributions of CRF, muscle mass, and strength. Additionally, they discuss the impact of fasting on muscle mass, the potential tradeoffs to consider, and finish by discussing why it?s critical to maximize your fitness level.

If you?re not a subscriber and listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #27 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

VO2 max and its association with cardiorespiratory fitness [2:45];
Changing mortality risk based on VO2 max and cardiorespiratory fitness [7:45];
The profound impact of improving cardiorespiratory fitness [15:15];
Muscle mass, function, and loss with aging: how it?s defined, measured, and the cutoff points for sarcopenia [25:00];
Increasing mortality risk associated with declining muscle mass and strength [40:00];
Muscle size vs. strength?which has the bigger impact on mortality risk? [58:00];
Evaluating the cumulative impact of cardiorespiratory fitness and muscular strength on mortality risk when put together [1:03:30];
Investigating the rising incidence in deaths from falls, and what role Alzheimer?s disease might play [1:09:00];
The impact of fasting on muscle mass and the potential tradeoffs to consider [1:14:30];
The critical importance of working to maintain muscle mass and strength as we age [1:20:30]; and
More.

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Show notes page for this episode: https://peterattiamd.com/ama27/ 

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2021-09-20
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#175 - Matt Kaeberlein, Ph.D.: The biology of aging, rapamycin, and other interventions that target the aging process

Matt Kaeberlein is globally recognized for his research on the biology of aging and is a previous guest on The Drive. In this episode, Matt defines aging, the relationship between aging, chronic inflammation, and the immune system, and talks extensively about the most exciting molecules for extending lifespan. He discusses the current state of the literature of testing rapamycin (and rapalogs) in animals and humans, including Matt?s Dog Aging Project, and provides insights into how we can improve future trials by conceptualizing risk, choosing better endpoints, and working with regulators to approve such trials. He also examines the connection between aging and periodontal disease, biomarkers of aging, and epigenetic clocks. Finally, they explore some of the biological pathways involved in aging, including mTOR and its complexes, sirtuins, NAD, and NAD precursors.

We discuss:

The various definitions of aging [3:25];
The relationship between disease and the biology of aging [16:15];
Potential for lifespan extension when targeting diseases compared to targeting biological aging [22:45];
Rapamycin as a longevity agent and the challenges of targeting the biology of aging with molecules [32:45];
Human studies using rapalogs for enhanced immune function [39:30];
The role of inflammation in functional declines and diseases of aging [50:45];
Study showing rapalogs may improve the immune response to a vaccine [56:15];
Roadblocks to studying gero-protective molecules in humans [1:01:30];
Potential benefits of rapamycin for age-related diseases?periodontal, reproductive function, and more [1:12:15];
Debating the ideal length and frequency of rapamycin treatment for various indications like inflammation and longevity [1:21:30];
Biomarkers of aging and epigenetic clocks [1:29:15];
Prospects of a test that could calculate biological age [1:37:45];
The Dog Aging Project testing rapamycin in pet dogs [1:42:30];
The role of the mTOR complexes [1:58:30];
mTor inhibitor called Torin2, mitochondrial disease and other potential pathways [2:09:45];
Catalytic inhibitors, sirtuins, and NAD [2:19:15];
NAD precursors: help or hype? [2:28:15]; and
More.

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2021-09-13
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#174 - Lawrence Wright: The 20th anniversary of the 9/11 attacks: reflections on how they happened, and lessons learned and not learned

Lawrence Wright is the author of The Looming Tower: Al-Qaeda and the Road to 9/11 which won the 2007 Pulitzer Prize for general nonfiction and was named one of Time's top 100 books of all time.  In this episode, released just before the 20th anniversary of the September 11th attacks, Lawrence and Peter discuss the book and the lasting impact of that day. Lawrence reflects on his personal experiences on that day and how he was first drawn into reporting on the attacks. Lawrence then discusses in detail the history that led up to 9/11 which is really composed of two parallel stories. The first story is of the growing discontent in Muslim countries, the roots of Islamic radicalism, and how two extremists, Osama bin Laden and Ayman al-Zawahiri, joined forces to create the global terrorist organization Al-Qaeda. The second story is about how interpersonal and institutional conflicts between the FBI and CIA led to a massive failure in intelligence and resulted in multiple missed opportunities to predict and prevent the attacks on September 11th, 2001. Finally, they reflect on what we should have learned from 9/11 and the future of terrorism.

 

We discuss:

Lawrence and Peter recount their personal experiences on September 11th, 2001 [3:30]; How 9/11 changed the US into a security state and affected a generation [9:45]; Lawrence?s early coverage of 9/11 and how he knew it was going to be ?the story of our lifetime? [14:45]; Egyptian politics and the foundation of radical Islam [22:45]; Anwar Sadat?s presidency, assassination, and the birth of the radical Islamic movement [33:00]; Aftermath of the Sadat assassination, and establishment of Al-Qaeda in Afghanistan [50:15]; Osama bin Laden: Upbringing, involvement in the Soviet?Afghan War, and rise to celebrity status in Saudi Arabia [56:00]; How the Western intervention in Saudi Arabia impacted Arab nationalist?s hatred of America [1:15:30]; Theorizing on the role of the religion in holding back Islamic states from making progress towards democracy [1:20:30]; Bin Laden?s time in Sudan [1:32:30]; The CIA vs. the FBI: setting the stage for the failure of US intelligence [1:37:00]; The mistake by US intelligence of not taking the bombings of the US embassies and the USS Cole seriously [1:46:00]; Al-Qaeda in America: Losing the planners of the 9/11 attacks from our clutches and incompetence at the FBI and CIA [1:56:00]; Problematic policies in Europe, and a direct message warning of the 9/11 attacks [2:14:45]; The role of political infighting and personality conflicts that helped enable the 9/11 attacks and the lack of accountability [2:22:45]; What came of the 9/11 commission, the role of the Saudi government, and the trials of Ali Soufan [2:36:00]; Lessons from 9/11 and the future of terrorism [2:46:30]; and More.

 

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2021-09-06
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#173 - AMA #26: Continuous glucose monitors, zone 2 training, and a framework for interventions

In this ?Ask Me Anything? (AMA) episode, Peter and Bob answer numerous follow-up questions to recently discussed deep-dive topics such as the use of continuous glucose monitors and getting the most from zone 2 exercise. They also discuss the incredible feats of cyclists in the Tour de France through the lens of the amazing performance physiology required from these athletes. Additionally, Peter ties the conversation together by sharing his foundational framework when considering different interventions, even in the absence of data from a randomized controlled trial.

If you?re not a subscriber and listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #26 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Peter?s foundational framework when considering different interventions [1:30];
Applying Peter?s framework to the idea of using a CGM [8:00];
Why certain fruits have a bigger impact on glucose, and the limitations of a CGM can tell you [16:00];
Importance of paying attention to insulin, and the prospects of a continuous monitor for insulin levels [20:00];
How exercise impacts glucose and peak glucose numbers to stay under [24:15];
Impact of anxiety on stress on glucose, and why it?s important to calibrate your CGM [26:30];
The five main tools for managing blood glucose numbers [33:45];
Benefits of moving or exercising after a meal, and where ingested carbohydrates get can be stored [37:15];
How to make decisions about an action or intervention in the absence of data from a rigorous, randomized controlled trial [40:30];
The incredible athletic feats of Tour de France cyclists [48:30];
Different modalities for doing zone 2 exercise: running, rowing, cycling, and more [1:00:15];
Proxies for knowing your in zone 2 short of using a lactate monitor [1:07:30];
Monitoring lactate for zone 2 exercise [1:10:00]; and
More.

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2021-08-23
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#172 - Esther Perel: The effects of trauma, the role of narratives in shaping our worldview, and why we need to accept uncomfortable emotions

Esther Perel is a psychotherapist and New York Times bestselling author who is an expert on modern relationships. In this episode, Esther describes how being a child of parents who narrowly survived the Holocaust shaped and influenced her perspectives and ultimately led to her to a career in therapy. She discusses how the generational differences in parenting, among other things, led to the rise of individualism with a focus on happiness and self-esteem to the detriment of our relationships and sense of community. Ultimately, the conversation focuses on the value of our relationships with others for one?s sense of wellbeing, ability to deal with past trauma, resilience, and even our lifespan. She uses real world case studies to emphasize the therapeutic value of creating healthy relationships with others and oneself, explaining how our relationships with others can be a mirror into our own maladaptive behaviors. Esther explains how our self-narratives, which are often shaped by past trauma, may negatively impact our relationships with others and our emotional health, and emphasizes the value in trying to change them when warranted.

 

We discuss:

Esther?s background, adventures in hitchhiking, and how she ended up in the US [2:30]; The lasting effects of the Holocaust on Esther?s parents [8:45]; Grappling with a dark past and feeling alive again after trauma [16:45]; How Esther came to understand her parents in a new light [23:15]; Why Esther chose therapy as her career [30:00]; Using the concept of sexuality to understand society, culture, and people [40:00]; The significance of sexual revolutions, and the similarities of medical advancements and advancements in psychotherapy [50:15]; The impact of the rise of individualism and the focus on happiness and self-esteem [56:00]; Generational differences in parenting and changing role of fathers [1:09:15]; How our narratives affect our sense of wellbeing and relationships with others, and the challenge of changing them [1:17:15]; Generational effects of past trauma, and how relationship to others can be a mirror into your maladaptive behavior [1:30:30]; The role of willpower in one?s ability change their behavior and improve their relationships [1:40:00]; How your relationships impact longevity and the importance of being capable of sitting in uncomfortable emotions [1:43:45]; Esther?s definition of resilience and the dangers of believing everything you think or feel [1:50:00]; Questions about the human condition that Esther wants to explore [1:57:30]; and More.

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2021-08-16
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#171 - Steve Austad, Ph.D.: The landscape of longevity science: making sense of caloric restriction, biomarkers of aging, and possible geroprotective molecules

Steve Austad is a distinguished professor of biology at the University of Alabama and director of one of the Nathan Shock Centers of Excellence in aging biology. Steve's current research seeks to understand the underlying causes of aging, specifically with a long-term goal of developing medical interventions that slow the age-related decay of human health. In this episode, Steve tells Peter about his unusual childhood and stints as a cab driver and lion tamer. He goes on to describe what led to his focus on studying aging and some of the major challenges and limitations of working with laboratory animals. Steve and Peter talk about the relationship between caloric restriction and lifespan, including some of the most important studies exploring this question. Additionally, they hypothesize what might explain the sex-related differences in longevity between men and women, explain the importance of finding longevity biomarkers, and discuss the most promising molecules as potential longevity agents.

We discuss:

Steve?s background and unusual childhood [2:30];
Steve?s adventures driving a cab in New York City [9:00];
How Steve drove to LA and accidentally became a lion tamer [13:30];
How Steve?s early graduate school experiences led him to study longevity [23:00];
The challenges and limitations of working with lab mice [30:45];
The connection between caloric restriction and lifespan [43:00];
Mice vs. rats and rodent aging experiments [51:15];
The impact of dietary composition and the harm of sucrose: Comparing two caloric-restriction studies in monkeys [56:00];
Challenges of studying animals due to major differences in the lab animal vs. wild animals [1:10:00];
Human studies of calorie restriction [1:24:45];
Better dietary protocols for humans: Alternatives to long-term caloric restriction [1:33:45];
The protective effect of fasting [1:38:00];
Reflecting on the sex differences in human lifespan, and why women have more neurodegenerative diseases [1:45:45];
The importance of identifying longevity biomarkers and which ones show the potential to change the landscape of longevity research [2:03:30];
Molecules showing the most promise as longevity agents [2:14:00]; and
More.

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2021-08-09
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#170 - AMA #25: Navigating the complexities and nuances of cancer screening

In this ?Ask Me Anything? (AMA) episode, Peter and Bob dive deep into cancer screening, including why it?s important, what you need to know about a test, and Peter?s approach with patients. They specifically discuss various screening methods, explain important terms like sensitivity and specificity, and how layering and stacking different tests in tandem can improve predictive values. They conclude with a discussion on one of the more exciting screening tools, diffusion-weighted MRI, and how it?s changing the cancer screening landscape.

If you?re not a subscriber and listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #25 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

The importance of cancer screening [1:15];
Cancer screening terms: sensitivity, specificity, false positives, and false negatives [8:25];
Cancer screening terms: positive and negative predictive value [17:00];
Improving predictive value by layering tests, and the predictive values of mammograms [25:45];
How smoking impacts the predictive value of cancer screening [30:45];
Liquid biopsies for ruling out cancer and the blind spots of common cancer screening tests [33:00];
The difference between cancer originating from inside versus outside the body [41:15];
How diffusion-weighted MRI is changing cancer screening [45:15];
Summary of Peter?s approach to cancer screening [53:45]; and
More.

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2021-07-26
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#169 - Katherine Eban: COVID-19 Lab Leak: Examining all sides of the debate and discussing barriers to a full investigation

 

Katherine Eban is an award-winning investigative journalist who previously appeared on The Drive to discuss the widespread fraud in the generic drug industry. In this episode, she discusses the content of her recent Vanity Fair article, which examined the evidence for the theory that the COVID-19 pandemic resulted from a virus lab escape as opposed to a natural virus that came from an animal host. Katherine and Peter walk through the evidence for both theories as well as discuss the long and troubling history of dangerous lab leaks and safety concerns about the Wuhan Institute of Virology.  They also talk about the controversy surrounding gain-of-function research and its funding by the US government. Finally, they conclude with a discussion on the likelihood of definitively establishing the origins of the virus given the Chinese government?s lack of cooperation and highlight the fact that the many barriers to performing a full investigation may be the most troubling aspect of the controversy. This episode was originally recorded on July 6, 2021. 

 

We discuss:

An overview of the lab leak controversy [1:30]; The troubling history of lab leaks of dangerous pathogens [8:30]; The zoonotic transmission theory: did SARS2 come from a bat? [11:45]; The debate about gain-of-function (GoF) research [26:15]; Questions about US funding of GoF research in China [33:45]; The uncertain significance of the furin cleavage site [51:30]; Discerning what?s most important about both the zoonotic transmission and lab leak theories [1:01:15]; Barriers to a full investigation [1:19:15]; and More.

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2021-07-19
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#168 - Hugh Jackman: Reflections on acting, identity, personal transformation, and the significance of being Wolverine

Hugh Jackman is an award-winning actor and an overall fascinating and introspective individual. In this episode, Hugh reflects upon his acting career, including how he navigated many tough decisions that led to important professional turning points for him. Peter and Hugh have an intimate discussion related to handling professional criticism, self-identity, spirituality, raising kids, and the role that past trauma often plays in extremely driven individuals. Hugh gives the inside scoop on some of his most well-known character roles and explains how he finds the energy to consistently perform. Finally, they tie the conversation together with a discussion on the importance of physical and mental health and wellbeing.

We discuss:

Hugh?s voracious curiosity and early years of his acting career [2:15];
Self-identity, overworking, and the importance of living well [9:15];
Handling criticism and letting go of the desire to please everyone [18:30];
Dismissing vitriol on social media, and the challenge of communicating science [28:15];
Going with your gut and the value in finding the right partner [31:30];
A hard decision that lead to a turning point in Hugh?s life [40:15];
How driven personalities often develop from a place of trauma, and how to avoid going from productive to destructive [47:00];
The effect of fame on Hugh?s family [58:45];
How Hugh finds the energy to consistently perform, and the spiritual connection he feels when acting [1:07:15];
Hugh?s experiences on the set of The Fountain and the meaning behind the film [1:26:30];
The potential of imagination, the idea of a higher power, and thoughts on science vs. religion [1:33:45];
The deep connection Hugh felt to Logan (his character in Wolverine) [1:41:45];
Reflections on physical aging, emotional wellbeing, and longevity [1:55:15]; and
More

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2021-07-12
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#167 - Gary Taubes: Bad science and challenging the conventional wisdom of obesity

Gary Taubes is an investigative science and health journalist and a best-selling author. In this podcast, Gary explains how he developed a healthy skepticism for science as he was transitioning from being a physics major to beginning as a science journalist. He talks about how he was particularly drawn to sussing out ?pathologic science,? telling the stories behind his books on the discovery of the W and Z bosons and cold fusion, emphasizing the need for researchers to perform a thorough background analysis. Gary then describes how his work came to focus on public health, nutrition, and obesity. He provides a great historic overview of obesity research and provides his explanation for why the conventional wisdom today is incorrect.
We discuss:

Gary?s background in science and journalism, and developing a healthy skepticism for science [2:20];
Gary?s boxing experience, and the challenge of appreciating behavioral risk [8:40];
How Gary developed his writing skills, and what the best science writers do well [16:45];
Example of how science can go wrong, and the story behind Gary?s first book, Nobel Dreams [25:15];
Theoretical vs. experimental physicists: The important differentiation and the relationship between the two [36:00];
Pathological science: research tainted by unconscious bias or subjective effects [40:30];
Reflecting on the aftermath of writing Nobel Dreams and the legacy of Carlo Rubbia [49:45];
Scientific fraud: The story of the cold fusion experiments at Georgia Tech and the subject of Gary?s book, Bad Science [53:45];
Problems with epidemiology, history of the scientific method, and the conflict of public health science [1:09:00];
Gary?s first foray into the bad science of nutrition [1:26:45];
Research implicating insulin?s role in obesity, and the story behind what led to Gary?s book, Good Calories, Bad Calories [1:36:15]
The history of obesity research, dietary fat, and fat metabolism [1:46:00]
The evolving understanding of the role of fat metabolism in obesity and weight gain [1:55:15]
Mutant mice experiments giving way to competing theories about obesity [2:04:00]
How Gary thinks about the findings that do not support his alternative hypothesis about obesity [2:08:00]
Challenges with addressing the obesity and diabetes epidemics, palatability and convenience of food, and other hypotheses [2:14:45];
Challenging the energy balance hypothesis, and the difficulty of doing good nutrition studies [2:25:00]; and
More.

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2021-06-28
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#166 - Patricia Corby, D.D.S.: Importance of oral health, best hygiene practices, and the relationship between poor oral health and systemic disease

Dr. Patricia Corby is Associate Professor of Oral Medicine and Associate Dean of Translational Research at Penn Dental Medicine. Her work focuses on the importance of providing dental services alongside critical public healthcare services, like cancer treatment. In this episode, Pat provides an overview of dental anatomy, the importance of oral hygiene to overall health, and the association of poor oral health and systemic diseases like cancer and diabetes. She addresses tooth decay, oral hygiene in children, the utility of dental products, and ideal oral care regimens for different populations. She also discusses issues specific to immunocompromised patients and those with chronic illnesses as well as her own research with cancer patients undergoing radiation treatment.

 

We discuss:

Anatomy of teeth and the purpose of the dental pulp?a highly vascularized and innervated region of the tooth [3:00]; Types of teeth and the different purpose they serve [14:15]; Anatomy of the oral cavity, bacteria in the mouth, and what a healthy mouth looks like [18:10]; Pat?s study demonstrating the importance of flossing [23:00]; Detrimental effects of sugar and the importance of fluoride and oral hygiene [31:45]; Oral health challenges for cancer patients and immunocompromised people [39:45]; Pat?s current research on cancer patients undergoing radiation treatment and the oral health risks associated with human papilloma virus (HPV) [50:00]; Periodontal disease: caries and root canals [57:30]; The relationship between poor oral health and systemic health diseases [1:11:00]; Potential connection between oral hygiene and COVID-19 [1:17:45]; Dry mouth leading to oral infections and ways to prevent it [1:22:30]; What determines the appearance of teeth, methods of teeth whitening, and whether you should remove mercury fillings [1:27:30]; Importance of fluoride for preventing tooth decay, and dental care for children [1:32:45]; Useful dental products: floss, electrics toothbrushes, and more [1:39:15]; Ideal oral care regimens [1:47:30]; and More. Learn more: https://peterattiamd.com/   Show notes page for this episode: https://peterattiamd.com/patriciacorby    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.
2021-06-21
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#165 - AMA #24: Deep dive into blood glucose: why it matters, important metrics to track, and superior insights from a CGM

In this ?Ask Me Anything? (AMA) episode, Peter and Bob dive deep into blood glucose and why it matters so much with respect to metabolic health and longevity. They explain the need to pay close attention to metrics like average blood glucose, glucose variability, and peak glucose numbers. Additionally, Peter explains why he encourages all his patients, even nondiabetics, to utilize a continuous glucose monitor (CGM) which gives important insights that traditional lab testing and metrics consistently miss.

If you?re not a subscriber and listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #24 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

 

We discuss:

The problem with traditional blood tests and metrics for determining metabolic health [1:10]; The superior insights from a continuous glucose monitor [6:15]; Why lower is better than higher: average glucose, glucose variability, and glucose peaks [12:00]; Deep dive into average blood glucose and the importance of having the lowest average blood glucose possible [14:45]; Deep dive into glucose variability and why less variability is better [33:15]; Example of how HbA1c and traditional measures could catch metabolic issues too late [41:45]; Postprandial dips in blood glucose as a predictor of subsequent hunger and energy intake [43:00]; Exploring the idea that the suppression of fatty acids is actually causing hunger rather than a low blood glucose [49:45]; Deep dive into peak glucose and why lower peaks is better [57:15]; What the best rodent models tell us about the impact of peak glucose levels [1:06:25]; Why Peter encourages all his patients to wear a CGM [1:14:30]; and More.

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2021-06-14
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#164 - Amanda Smith, M.D.: Diagnosing, preventing, and treating Alzheimer?s disease, and what we can all learn from patients with dementia

Amanda Grant Smith is a geriatric psychiatrist with decades of experience treating patients with dementia and Alzheimer's disease. In this episode, Amanda shares how she developed a passion for geriatric psychiatry as a means to support dementia patients. She explains how to recognize, define, and diagnose dementia?a process that still remains somewhat elusive. They also talk about the significance of ApoE genotype and compare the various forms of dementia including differentiating between Alzheimer?s disease and Lewy body dementia. They discuss the current landscape of clinical trials, the drug pipeline, and talk about a very promising monoclonal antibody directed at amyloid beta that has the potential to be a disease-modifying drug. They conclude with a discussion about how to define ?healthy aging? and reflect on how understanding dementia can shape one?s life philosophy.

 

We discuss:

How Amanda developed a passion for geriatric psychiatry [3:15]; Defining and diagnosing dementia and Alzheimer?s disease [13:30]; Medical tests for dementia and their relationship to clinical symptoms [22:45]; The pathology of dementia, and the role of the tau and beta-amyloid protein in Alzheimer?s disease [33:15]; The significance of ApoE genotype, and differentiating Alzheimer?s disease from Lewy body dementia [43:15]; The evolution of Alzheimer?s disease prevention, care, and medications over the last 20 years [52:45]; Psychiatric support for dementia patients (and caregivers) with depression and anxiety [1:02:45]; Drug pipeline, clinical trials, and major challenges to overcome [1:13:45]; Redefining Alzheimer?s disease and designing effective trials [1:23:00]; The promise of monoclonal antibody treatments for Alzheimer?s disease [1:34:15]; How we should measure outcomes in dementia trials and define ?healthy aging? [1:42:30]; How understanding dementia can reshape our life philosophy [1:53:45]; and More.

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2021-06-07
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#163 - Layne Norton, Ph.D.: Building muscle, losing fat, and the importance of resistance training

Layne Norton is a physique coach, a natural professional bodybuilder and powerlifter, and holds a Ph.D. in nutritional sciences. In this episode, Layne explains how he became interested in weightlifting and fitness both professional and academically. He provides insights into preventing and managing injuries while using consistency and determination to boost his professional success in bodybuilding and powerlifting. Peter and Layne also review the science of body composition and what?s really driving muscle growth, including the role of nutrition, supplements, and a number of important and misunderstood hormones important to muscle protein synthesis. Furthermore, Layne stresses the importance of maintaining muscle mass even while losing fat for improving metabolic health and longevity and provides the keys to developing healthy habits. 

 

We discuss:

Layne?s childhood and why he gravitated towards weightlifting and bodybuilding [2:45]; Layne?s academic path, overcoming ADHD, and kicking Adderall [11:45]; Paradoxical observations about expertise, and Layne?s career transition to health and fitness [22:00]; The power of persistence and resilience in the face of setbacks [32:15]; Battling injuries, managing back pain, and setting lifting records [43:00]; Bodybuilding vs. powerlifting: comparing and contrasting the training approaches [57:15]; Cutting weight without losing muscle mass: exercise and dietary protocols, fasting, and a look at the literature [1:06:00]; Muscle protein synthesis and the importance of leucine [1:25:30]; Nitrogen balance and muscle protein synthesis, and the regulatory role of hormones for fat flux and muscle growth [1:37:00]; What?s really driving muscle growth: intrinsic vs. systemic factors, IGF, and hormone signaling [1:46:30]; The role of protein, carbohydrates and insulin on muscle growth and preservation, and the importance of context when interpreting study results [1:55:30]; Clarifying the role of cortisol?a misunderstood hormone [2:07:45]; The problem with studies trying to isolate one nutrient [2:15:00]; The important role of inflammation from exercise [2:19:25]; Keys to preserving muscle, and the value of habits, consistency, and resilience [2:23:30]; and More.

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2021-05-24
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#162 - Sarah Hallberg, D.O., M.S.: Challenging the status quo of treating metabolic disease, and a personal journey through a grim cancer diagnosis

Sarah Hallberg is the Medical Director at Virta Health and a physician who has spent nearly two decades treating patients with obesity and type 2 diabetes. In the first half of this episode, Sarah discusses how she became a huge believer in the efficacy of carbohydrate restriction for the treatment of type 2 diabetes through her research and clinical experience. Sarah challenges the common beliefs about the role of dietary fat and carbohydrate on the plasma makeup of fatty acids and triglycerides. She also expresses the importance of understanding early predictors of metabolic illness?highlighting one particular fatty acid as the most important early predictor?before finishing with a discussion about how doctors might be able to personalize patients? metabolic management in the future. In the second half of this episode, Sarah tells the personal story of her own lung cancer diagnosis. She talks about dealing with her grief, deciding to continue her work while prioritizing her family, and how she devised a plan to extend her survival as long as possible.  

 

We discuss:

How Sarah discovered the profound impact of carbohydrate restriction for reversing obesity and type 2 diabetes [3:15]; Prediabetes and metabolic syndrome: prevalence, early signs, and the importance of treating early [16:00]; Overview of fatty acids, how they are metabolized, and understanding what you see in a standard blood panel [29:15]; The relationship between diet composition and metabolic markers [35:15]; Why palmitoleic acid is such an important biomarker [48:15]; The best early indicators of metabolic disease [1:00:00]; Personalized management of metabolic illness [1:07:00]; Sarah?s cancer diagnosis and the beginning of her journey [1:15:15]; The emotional impact of a devastating diagnosis [1:27:15]; Sarah?s plan to extend survival [1:36:45]; Sarah?s aggressive treatment plan [1:47:30]; Life-threatening complications and the return of her cancer [1:59:00]; Sarah?s reflections on her approach to life with chronic cancer and balancing her time [2:11:00]; and More.

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2021-05-17
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#161 - AMA #23: All Things Nicotine: deep dive into its cognitive and physical benefits, risks, and mechanisms of action

In this ?Ask Me Anything? (AMA) episode, Peter and Bob dive deep into nicotine, a complicated and interesting molecule that has effects on both the brain and the body. They analyze the results of the studies that describe nicotine?s cognitive benefits and potential for inducing weight loss. They talk about a smoking cessation technique called nicotine replacement therapy and give a full breakdown of the various routes of administration, dosing, and safety. Finally, they explore the fascinating and counterintuitive observation that cigarette smokers are less likely to get a severe case of COVID-19.

If you?re not a subscriber and listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #23 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

How Peter first became interested in the potential benefits of nicotine [1:15];
Untangling nicotine from tobacco [6:00];
Nicotine replacement therapy (NRT) for quitting smoking: products, protocols, and a review of the literature [9:30];
The cognitive benefits of nicotine: Overview of the literature [15:50];
Where nicotine has the most positive impact on cognition [30:30];
Possible mechanisms conferring the benefits of nicotine [37:00];
How modafinil and other nootropics compare to nicotine [47:15];
How nicotine may induce weight loss [54:00];
Relationship between smoking and COVID-19: Analyzing the observation that smoking appears protective against COVID-19 [1:01:45];
Breakdown of the various nicotine replacement therapies: route of administration, dosing, and safety [1:11:30];
Concluding thoughts on nicotine: use cases, addictive properties, and more [1:19:45]; and
More.

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2021-05-10
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#160 - Paul Offit, M.D.: The latest on COVID-19 vaccines and their safety, herd immunity, and viral variants

Paul Offit is a pediatrician specializing in infectious diseases and an expert in virology and vaccine development. He currently serves on the FDA committee evaluating COVID-19 vaccines. In this episode, Paul?s second appearance on The Drive, he provides an update on all the SARS-CoV-2 vaccines currently deployed, explains why the concerns raised around the mRNA vaccines are not legitimate, and offers his view on the prospects and timeframe of reaching herd immunity. He also takes a deep dive into immunology, explaining the short-term and long-term immune response to both natural infection and vaccination and how these two can function together to provide durable immunity. Additionally, they discuss the theories on the origins of this virus, what impact the new COVID-19 variants might have, and the recent pausing of the J&J vaccine. Finally, they discuss how we can be better prepared for an inevitable future outbreak of a novel virus. This episode was originally recorded on April 14, 2021.

We discuss:

Overview and current status of the SARS-CoV-2 vaccine strategies [4:10];

Addressing concerns about mRNA vaccines [9:00];

How the failure to make an effective HIV vaccine aided the development of a COVID-19 vaccine [16:45];

Where SARS-CoV-2 falls on the spectrum of its ability to mutate and what that means for immunity and vaccination [21:30];

How the combination of short-term and long-term immune response to SARS-CoV-2 work together to provide durable immunity [28:00];

Importance of understanding relative vs. absolute risk reduction [38:15];

Implications of pausing the J&J vaccine due to reports of blood clotting in the brain [42:45];

What constitutes herd immunity and the concerns of rising vaccine hesitancy [47:45];

When we might reach herd immunity, future vaccines for children, and long-term outlook for maintaining population immunity [58:45];

Theories about the origins of SARS-CoV-2 [1:07:00];

Preparing for the possibility of a future pandemic and how we can learn from our mistakes [1:10:40]; and

More.

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2021-05-03
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#159 - Peter Hotez, M.D., Ph.D.: Evolution of the anti-vaccine movement, the causes of autism, and COVID-19 vaccine state of affairs

Peter Hotez is an internationally recognized physician-scientist in neglected tropical diseases and vaccine development. In this episode, they first follow up on the podcast episode (#158) with Brian Deer (the investigative journalist who exposed the complex and disturbing story behind the infamous 1998 Lancet paper by Andrew Wakefield linking the MMR vaccine and autism) with a broader discussion about the origin and evolution of the anti-vaccine movement. They explore some of the specific claims being made around vaccine additives, the timing of when vaccines are given, and claims about issues with the HPV vaccine specifically. Next, Dr. Hotez shares his own journey as a parent of an autistic child and speaks of the challenges of diagnosing autism, what could account for the seeming increase in the prevalence, and whether there is any support for the notion that environmental triggers play a role. They close out with a discussion on the state of affairs with respect to COVID-19 vaccination, comparing the various vaccines as well as the challenges that emerging variants of the virus may present. This episode was originally recorded on April 2, 2021.

 

We discuss:

The stubborn persistence of anti-vaccine sentiment (3:00); A closer look at claims about thimerosal and vaccine spacing causing autism (12:00); The Hib vaccine: An example of the profound difference a vaccine can make (23:30); The controversy surrounding the human papillomavirus (HPV) vaccine (30:45); The growing anti-science sentiment, COVID vaccine hesitance, and the basis of the anti-vaxx movement (39:00); The origins of autism, and Hotez?s personal story as a parent of an autistic child (1:02:45); The challenge of diagnosing autism, increasing prevalence, and a potential parallel to Alzheimer?s disease (1:14:15); Comparing the various COVID-19 vaccines and the impact of emerging variants of the virus (1:30:00); Global vaccination challenges and ?vaccine diplomacy? (1:40:45); and More.

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2021-04-26
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#158 - Brian Deer: A tale of scientific fraud?exposing Andrew Wakefield and the origin of the belief that vaccines cause autism

Brian Deer is an award-winning investigative journalist best known for his coverage of the pharmaceutical industry. In this episode, he and Peter discuss the content of his book, The Doctor Who Fooled the World: Science, Deception, and the War on Vaccines, which exposes the complex and disturbing story behind the infamous 1998 Lancet paper by Andrew Wakefield linking the MMR vaccine and autism. Brian explains how doctors led by Wakefield, a lawyer, and an anti-vaccination parents? group worked together on a study to validate their preconceived belief that the MMR vaccine caused autism. He reveals what happened behind the scenes as the study was carried out, explains problems in the lab, and discusses inconsistencies in the analysis.  In the end, this is a story that serves as a cautionary tale about the consequences of science driven by an agenda rather than by a spirit of open inquiry.

 

We discuss:

How Andrew Wakefield?s flawed approach to scientific research led to the belief that vaccines cause autism (3:25); The importance of following the scientific method, and how Wakefield twisted the science to link measles virus to Crohn?s disease (14:15); The backstory behind Andrew Wakefield?s infamous 1998 Lancet paper linking the MMR vaccine and autism (26:45); The many flaws and disturbing aspects of Wakefield?s study: suffering children and failure to do strain-specific sequencing (45:15); The epicenter of fraud: Bogus PCR testing furthering the belief that measles virus from the MMR vaccine caused autism (1:00:00); Additional issues that contaminated the study results (1:22:15); Discovering the misrepresented medical records for the kids involved in the study leading to the retraction of the Lancet paper and Wakefield losing his license (1:31:00); The resurgence of the anti-vaccination movement, Brian?s motivation to write the book, and parting thoughts (1:36:45); and More.

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2021-04-19
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#157 - AMA #22: Losing fat and gaining fat: the lessons of fat flux

In this ?Ask Me Anything? (AMA) episode, Peter and Bob take a deep dive into fat flux. They define the major players that impact the flow of fat entering and exiting a fat cell, which determines how much fat a person carries. They discuss the significant influence that insulin has on the net fat balance and explore common strategies, such as fasting and low-carb diets, that have efficacy in the liberation and oxidation of fat from fat cells. Additionally, Bob explains his research process and how he seeks answers to Peter?s challenging questions.  

If you?re not a subscriber and listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #22 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

 

We discuss:

The two main ways to reduce fat mass (1:30); Explaining fat flux?how fat enters and exits a fat cell (9:15); What fat balance looks like (21:15); What net fat influx looks like, and the impact of insulin in lipolysis (24:30); What net fat efflux looks like, and the benefits of fasting to break the hyperinsulinemic cycle (28:30); Exploring why most people with excess body fat will lose fat mass when reducing carbohydrates or eating a ketogenic diet (32:45); Why being in nutritional ketosis does not automatically translate to negative fat flux (fat loss) (42:40); Bob?s approach to scientific research (47:00); The importance of curiosity and a desire to learn (58:30); Bob?s tips and tricks for answering a scientific question in a time-crunch (1:00:00); and More.

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2021-04-12
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#156 - Jake Muise: Humanely harvesting axis deer while alleviating its impact on Hawaii?s vulnerable ecosystems

Jake Muise is an avid hunter, environmentalist, and advocate for the preservation of Hawaii?s natural resources. He is the founder of Maui Nui Venison, a company which actively manages Hawaii?s imbalanced population of axis deer by harvesting them as a food resource. In this episode, Jake tells his unbelievable backstory growing up in Northern Alberta before landing in Hawaii on a volleyball scholarship where he fell in love with the islands and the people. Jake explains how axis deer?a non-native species?were brought to the islands and how they have since become imbalanced to the detriment of Hawaii?s precious ecosystems. He goes on to explain the incredible lengths that his company has taken to ensure the most humane harvesting techniques imaginable resulting in a food source that is as clean and healthful as can be. Additionally, Jake and Peter examine what makes meat from axis deer one of the most nutrient-dense red meats on the planet.

 

We discuss:

Upbringing in Northern Alberta, a diet of moose meat, and learning to surf in Nova Scotia (3:35); How volleyball brought Jake to Hawaii where he met the Molokai people (14:00); Jake?s introduction to axis deer (26:30); Pro volleyball in Europe, missing the Olympic team by one spot, and his return to Hawaii (29:00); History of axis deer in Hawaii?how a non-native species came to the islands, and the superpowers that make them so hard to hunt (34:00); A potential catastrophe avoided on The Big Island?The amazing story of how Jake tracked and found axis deer that were secretly brought to The Big Island (52:15); Jake?s work helping ranchers on Maui (1:08:15); The detrimental impact of an imbalanced axis deer population (1:10:30); The incredible evacuation of farm animals from lava-locked land due to a volcano eruption (1:17:00); The creation of Maui Nui Venison?going above and beyond USDA requirements (1:27:00); The most humane way to harvest an animal?the unmatched standards Maui Nui Venison uses to harvest axis deer (1:32:00); Why meat from axis deer is nutritionally superior (and tastes better) than other meats (1:46:00); Why axis deer meat is the best option for those reluctant to eat meat: True nose-to-tail nutrition and ethical harvesting (1:58:15); What a truly balanced population of axis deer on Hawaii would look like (2:06:15); Maui Nui Venison?s charitable work during the COVID crisis (2:12:45); and More.

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2021-04-05
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#155 - Chris Sonnenday, M.D.: The history, challenges, and gift of organ transplantation

Chris Sonnenday is the Transplant Center Director for Michigan Medicine. As Peter?s senior resident while at Johns Hopkins, Chris made a lasting impression on him with his remarkable leadership and ability to maintain his humanity through the stressors of that challenging environment. In this episode, Chris tells the incredible backstory of the history of transplant medicine, focusing on the kidney and the liver. He discusses the surgical and immunologic developments that launched the field forward, but also lays out the challenges ahead for the field, such as the rising prevalence of chronic kidney and liver failure. Chris also tells many stories of tragedy and triumph that comes with working in organ transplantation, but ultimately explains the rewarding nature of being a witness to the gift of organ donation.

 

We discuss:

What attracted Chris to medicine, and his leadership in residency (3:30); How Chris maintained his empathy and humanity through the stresses of med school and residency (8:30); Why Chris chose a complicated field like transplant medicine (23:15); Explaining kidney transplantation to showcase the challenge of organ transplantation surgery (28:00); Overcoming the immune-based challenges of transplant surgery (37:00); How the discovery of cyclosporine transformed the field of organ transplantation (49:00); Rising chronic kidney failure due to the prevalence of pre-diabetes and metabolic syndrome (53:45); Why living kidney donations are superior, and the possibility of a market for kidney donation (59:30); Designing a fair system of organ distribution (1:17:30); The debate on what constitutes ?death? when deciding when to take organs from a registered organ donor (1:21:45); Reflections on the gift of organ donation (1:33:15); The history of liver transplantation and why it?s so complex (1:39:15); Addressing acute liver failure and the amazing baboon experiment (1:46:15); The potential for the rising prevalence of NAFLD and NASH to overwhelm the liver transplant infrastructure in the US (1:54:45); The importance of teamwork in successful organ transplantations, and the most tragic event Chris has ever witnessed (2:05:45); and More.

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2021-03-29
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#154 - Steve Levitt, Ph.D.: A rogue economist?s view on climate change, mental health, the ethics of experiments, and more

Steven Levitt is a professor of economics at the University of Chicago and the co-author of the bestselling book Freakonomics and its two sequels. In this episode, Steve discusses his unlikely path to a career in economics and his view of the current state, and limitations, of the field. He also gives his unique perspective on contemporary issues including climate change, mental health in education, how to evaluate whether an experiment is ethical, decision making, horse racing, and much more. 

 

We discuss:

How Steve ended up in economics (2:45); Current trends in the field of economics: macro vs. micro, usefulness of models, and the relationship between data and theory (8:45); Revisiting what Steve wrote about climate change in SuperFreakonomics, and why it?s unlikely to be solved with behavioral change (18:45); The consequences of a blurred line between climate science and advocacy (27:30); Answering climate questions with a ?Manhattan Project for climate change? (31:45); Steve?s reflections on his career path and how he found his way by being himself (40:00); How Steve came to write Freakonomics (and its sequels), and the topics which caused the most controversy (53:00); How Steve came to appreciate mental health through parenting, and the need to emphasize mental health into the education system (1:10:15); Why people are bad at making decisions (1:26:45); Deliberating on why horse racing times haven?t advance much in decades (1:34:30); Reducing the impact of negative emotions by observing the world free of language (1:44:00); Changing our thinking about what it means to conduct experiments ethically (1:49:00); and More.

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2021-03-22
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#153 - AMA #21: Deep dive into olive oil, high-intensity exercise, book update, and more

In this ?Ask Me Anything? (AMA) episode, Peter and Bob take a deep dive into olive oil. They explore the history of olive oil, discuss observational data that led to the hypothesis that olive oil is a healthier alternative to many other fats, and they explain the classification of olive oil types ?including what to look for in a high-quality ?extra virgin? olive oil. Peter and Bob round out the discussion with a ?two-minute drill,? in which Peter answers questions from subscribers. They cover zone 5 training, an update on Peter?s book, lactate meters, standing desks, massage guns, electrolyte supplementation, and more. 

 

If you?re not a subscriber and listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #21 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

 

We discuss:

The early history of olive oil and the Mediterranean diet (2:15); The three broad categories of fats: SFA, MUFA, and PUFA (6:25); Exploring the hypothesis that olive oil is healthy (10:30); Comparing olive oil to the makeup of other common oils (30:00); Defining ?extra virgin? olive oil, what to look for when purchasing, and Peter?s favorite brand (34:30); Update on Peter?s book (47:15); Zone 5 training: Peter's approach to zone 5 training, and other anaerobic training protocols (49:30); Advantages of using a standing desk compared to sitting (55:30); Lactate meters and strips (57:45); Electrolyte supplementation during fasting and ketosis, and why uric acid may increase (59:30); The usefulness of massage guns, foam rollers, and professional massage for muscle pain and tightness (1:01:30); and More.

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2021-03-15
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#152 - Michael Rintala, D.C.: Principles of Dynamic Neuromuscular Stabilization (DNS)

Michael Rintala is a sports medicine chiropractor and one of only 18 international instructors teaching dynamic neuromuscular stabilization (DNS) for the Prague School of Rehabilitation. This episode focuses on understanding DNS, including the foundational principles and how it relates to human motor development. Michael also shares the most common injuries and issues he sees in patients in his practice, such as postural problems and back pain, and how the movements of a DNS program are used to avoid injury, maintain longevity, and improve sports performance.


We discuss:

Michael?s background in chiropractic sports medicine and rehabilitation (3:15); The Prague School of Rehabilitation, and functional rehabilitation as the foundation of the dynamic neuromuscular stabilization (DNS) program (5:00); Foundational principles of DNS, and the role of the diaphragm in muscular stability (19:00); Types of muscle contractions (28:15); Human motor development through the lens of DNS, and when issues begin to arise (32:30); Common postural syndromes (50:00); Increasing functional threshold to minimize time in the functional gap (56:45); DNS for injuries, pain, pre-habilitation, and performance enhancement (1:03:45); Etiology of back pain (1:10:00); How a stress fracture in his back led Michael to the Prague School (1:16:00); The Prague School curriculum: 3 tracks for certification in DNS (1:20:45); and More.

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2021-03-08
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#151 - Alex Hutchinson, Ph.D.: Translating the science of endurance and extreme human performance

Alex Hutchinson is a sports science journalist, author of the book Endure?which explores the science of endurance and the real limits of human performance?and former competitive runner for the Canadian national team. In this episode, Alex tells the story of his ?aha moment? during a meaningless track meet that catapulted his running career and seeded his interest in the power of the mind. He then explains the science behind VO2 max, the difference between maximum aerobic capacity and efficiency, and extracts insights from examples of extreme human performance, such as the recent attempts to break the 2-hour mark in the marathon. Finally, he brings it back to what this all means for the everyday person: optimal exercise volume for maintaining health, how to avoid acute and chronic injuries, how to diversify your exercise portfolio, HIIT protocols, and much more.

 

We discuss:

Alex?s background and passion for running (3:00); The power of the mind: Alex?s ?aha moment? that catapulted his running career (9:00); Pursuing a Ph.D. in physics while prioritizing his running career, and doing the hardest thing possible (19:00); Career transition to journalism, tips for improving your writing, and insights from the best writers (26:00); Breaking down VO2 max: Definition, history, why it plateaus, and whether it really matters (38:15); The case study of Oskar Svensson: Why a higher VO2 Max isn?t always better, and the difference between maximum aerobic capacity and efficiency (49:15); The sub 2-hour marathon: The amazing feat by Kipchoge, and what will it take to ?officially? run a 2-hour marathon (1:01:00); Comparing the greatest mile runners from the 1950s to today (1:14:45); How the brain influences the limits of endurance (1:20:15); Relationship between exercise volume and health: Minimum dose, optimal dose, and whether too much exercise can shorten lifespan (1:23:45); Age-associated decline in aerobic capacity and muscle mass, and the quick decline with extreme inactivity (1:40:45); Strength or muscle mass?which is more important? (1:47:00); Avoiding acute and chronic injuries from exercise (1:48:45); High intensity interval training: Evolution of the Tabata protocol, pros and cons of HIIT training, and how it fits into a healthy exercise program (1:54:15); The importance of understanding why you are engaging in exercise (2:03:00); How we can encourage better science journalism and reduce the number of sensationalized headlines (2:05:45); and More.

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2021-03-01
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#150 - Senator Bill Frist, M.D.: A modern Renaissance man's journey through science, politics, and business

Bill Frist is a nationally acclaimed heart and lung transplant surgeon, former U.S. Senate Majority Leader, and is actively engaged in health policy and education reform. In this episode, Bill takes us through his long and varied career in medicine, politics, and business, which includes establishing the organ transplantation program at Vanderbilt as well as rising from the lowest-ranked member of the U.S. Senate to the Majority Leader in two terms. We discuss some of the most significant moments of his time in the Senate, such as advocating for AIDS prevention programs' funding and addressing complicated issues like stem cell research and the end-of-life issues raised by the Terri Schiavo case. We also hear his first-person account of what happened behind the scenes on September 11, 2001, his frustration with our lack of preparation for the pandemic, and his thoughts about the current state of U.S. politics. Finally, we talk about his current endeavors in health policy and education reform.

We discuss:

Bill?s decision to pursue medicine and do organ transplants (3:40); The miraculous nature of organ transplants: History, Bill?s work, and the most exciting things to come (12:00); Frist?s experience building up the heart transplant program at Vanderbilt (21:45); The famous rivalry between surgeons Denton Cooley and Michael DeBakey (29:15); How the medical field can attract bright young people to pursue medicine (33:00); Bill?s decision to leave medicine and run for the US senate (38:00); The value in having scientists and physicians in Congress (47:30); A discussion on whether or not senators should have term limits (55:30); The highly polarized nature of politics, and how we can fix it with empathy (1:00:30); Bill?s time in the Senate and quick rise to Senate Majority Leader (1:05:30); The lifesaving impact of the President's Emergency Plan for AIDS Relief (PEPFAR) under George W. Bush (1:15:15); How Bill reversed course on his view of the value and morality of stem cell research (1:19:45); Complex end-of-life decisions, and Bill?s role in the infamous Terri Schiavo case?a story that captures the conflict among law, morality, and improving technology (1:30:00); Remembering the events of September 11th from Bill?s perspective in the Senate (1:49:45); The coronavirus pandemic: Bill?s accurate 2005 prediction, and a discussion about future preparedness (1:56:45); The divided state of US politics, and how we can come together (2:06:45); How experience in medicine and politics is shaping Bill?s current endeavors in business, reforming education, palliative care, and more (2:12:45); and More. Learn more: https://peterattiamd.com/   Show notes page for this episode: https://peterattiamd.com/BillFrist    Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/   Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/   Connect with Peter on Facebook | Twitter | Instagram.
2021-02-22
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#149 - AMA #20: Simplifying the complexities of insulin resistance: how it's measured, how it manifests in the muscle and liver, and what we can do about it

In this ?Ask Me Anything? (AMA) episode, Peter and Bob discuss all things related to insulin resistance by revisiting the important points made in the fascinating, yet quite technical, episode of The Drive with Gerald Shulman. They devote the entire discussion to understanding the condition known as insulin resistance, how it?s measured, how it manifests in the muscle and liver, and ultimately, what we can do about it.

If you?re not a subscriber and listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #20 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Explaining the format of this AMA: Extracting insights from Gerald Shulman?s masterclass on insulin resistance (2:00); The basics of insulin, defining insulin resistance (IR), and gold-standard methods of quantifying IR in the muscle (7:15); Practical ways to test for insulin resistance in a normal clinical setting (15:45); How insulin resistance manifests in the muscle (23:00); The biochemical block in glycogen synthesis?drivers and mechanisms resulting in insulin resistance in the muscle (30:45); The disparity in fat oxidation between insulin-sensitive and insulin-resistant individuals (44:45); The fate of the ingested carbohydrate in someone who is insulin resistant (51:00); The prevalence and clinical phenotype of insulin resistance (1:00:15); The role of exercise in mitigating and reversing insulin resistance (1:05:00); How insulin resistance manifests in the liver (1:09:15); Biggest takeaways: what we can do to mitigate and prevent insulin resistance (1:20:45); and More.

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2021-02-15
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#148 - Richard Miller, M.D., Ph.D.: The gold standard for testing longevity drugs: the Interventions Testing Program

Richard Miller is a professor of pathology and the Director of the Center for Aging Research at the University of Michigan. He is one of the architects of the NIA-funded Interventions Testing Programs (ITPs) animal study test protocol. In this episode, Rich goes through the results of the long list of molecules tested by the ITP?including rapamycin, metformin, nicotinamide riboside, an SGLT-2 inhibitor called canagliflozin, and more. Many of the discussed outcomes have had surprising outcomes?both positive and negative findings.

We discuss:

Rich?s interest in aging, and how Hayflick?s hypothesis skewed aging research (3:45); Dispelling the myth that aging can?t be slowed (15:00); The Interventions Testing Program?A scientific framework for testing whether drugs extend lifespan in mice (29:00); Testing aspirin in the first ITP cohort (38:45); Rapamycin: results from ITP studies, dosing considerations, and what it tells us about early- vs. late-life interventions (44:45); Acarbose as a potential longevity agent by virtue of its ability to block peak glucose levels (1:07:15); Resveratrol: why it received so much attention as a longevity agent, and the takeaways from the negative results of the ITP study (1:15:45); The value in negative findings: ITP studies of green tea extract, methylene blue, curcumin, and more (1:24:15); 17?-Estradiol: lifespan effects in male mice, and sex-specific effects of different interventions (1:27:00); Testing ursolic acid and hydrogen sulfide: rationale and preliminary results (1:33:15); Canagliflozin (an SGLT2 inhibitor): exploring the impressive lifespan results in male mice (1:35:45); The failure of metformin: reconciling negative results of the ITP with data in human studies (1:42:30); Nicotinamide riboside: insights from the negative results of the ITP study (1:48:45); The three most important takeaways from the ITP studies (1:55:30); Philosophies on studying the aging process: best model organisms, when to start interventions, which questions to ask, and more (1:59:30); Seven reasons why pigs can't fly (2:08:00); and More. Learn more: https://peterattiamd.com/   Show notes page for this episode: https://peterattiamd.com/RichardMiller    Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/   Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/   Connect with Peter on Facebook | Twitter | Instagram.
2021-02-08
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#147 - Hussein Yassine, M.D.: Deep dive into the ?Alzheimer?s gene? (APOE), brain health, and omega-3s

Hussein Yassine is a physician and researcher who studies brain lipid utilization in the context of finding preventative measures for cognitive impairment, specifically Alzheimer?s disease (AD). In my conversation with Hussein, we begin with a fundamental coursework in brain biology?including its architecture and energy systems. We go on to discuss what these systems look like when something goes wrong and cognitive decline ensues. We talk about the evolutionary origins of the ApoE genotype, with specific attention to the ApoE4 allele and its association with AD. We spend time discussing ApoE4 implications for the brain?s fuel utilization, notably omega-3 fatty acids: EPA and DHA. We briefly pivot to the implications of recent omega-3 trials for cardiovascular disease and return to what we currently understand about EPA/DHA and brain health; we contemplate potential dietary interventions across the lifespan to preserve and prolong cognitive function.

We discuss:

Hussein?s Background and introduction to brain composition (3:00); The blood-brain barrier and brain filtration (8:00); Lipids and brain function (13:00); How the brain utilizes energy (18:00); Apolipoprotein E (ApoE) structure and function in the periphery (27:30); ApoE function in the brain (38:15); Evolutionary origins of ApoE isoforms (43:45); ApoE4 variant and Alzheimer?s disease (AD) risk (53:30); Dietary fuel preference with the ApoE4 allele (1:03:00); The role of omega-3 fatty acids in the brain (1:13:30); Comparing findings from the REDUCE-IT and STRENGTH trial (1:21:45): The relationship between dietary omega-3 intake and brain health (1:34:15); Preventing cognitive decline: A critical window for DHA in ApoE4 carriers? (1:42:30); Hussein?s ongoing research and recommendations for E4 carriers (1:54:00); and More.

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2021-02-01
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#146 - Guy Winch, Ph.D.: Emotional first aid and how to treat psychological injuries

Guy Winch is a psychologist, author, and co-host of the Dear Therapist podcast. In this episode, Guy speaks to the commonality of the human condition with relatable stories from his decades of therapy sessions as well as his own experience with incessant rumination in the early days of his private practice. He shares insights on what he sees as an epidemic of rumination that leads to career burnout, the consequences of social comparison heightened by social media, and the psychological impact of not recognizing success. He emphasizes the need for a ?psychological medicine cabinet? and provides concrete and practical tools for treating emotional injuries. He concludes with a discussion about the widespread impact of the coronavirus pandemic on emotional health and how we can use experienced psychologists in a time when it?s especially needed.

We discuss:

The unique format and impetus for Guy?s podcast with Lori Gottlieb (3:00); How Guy pieced together the many different schools of thought in psychology to develop his own unique approach (7:45); The most important component of successful therapy, and why it sometimes makes sense to ?break the rules? (19:30); Insights extracted from Guy?s own battle with extreme stress and anxiety around finishing his education and starting his private practice (28:15); The epidemic of rumination, burnout, and the inability to psychologically leave work (34:15); Antidotes to incessant rumination, and tips for transitioning from work to home to avoid burnout (41:15); The psychology of complaining: The hidden cost of complaining incorrectly and benefits of learning how and when to complain (52:30); The consequences of social comparison, and the impact of ?failure? on emotional health (1:02:15); How Guy helps people who struggle to acknowledge any level of success (1:07:30); Emotional first aid: The importance of a psychological medicine cabinet for treating emotional injuries (1:19:00); The role of therapists in normalizing the discussion of emotional injuries and illuminating the commonality of feelings (1:27:45); The widespread impact of the coronavirus pandemic on emotional health (1:35:15); How to properly use affirmations?a tool for treating psychological injuries (1:42:00); The importance of nuanced language and the stories we tell ourselves (1:47:30); Peter?s favorite episode of the Dear Therapist Podcast (1:53:15); and More.

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2021-01-25
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#145 - AMA #19: Deep dive on Zone 2 training, magnesium supplementation, and how to engage with your doctor

In this ?Ask Me Anything? (AMA) episode, Peter and Bob take a deep dive into zone 2 training. They begin with a detailed definition of zone 2 and continue by discussing the importance of adding it to your exercise regimen. They talk about how to program zone 2 training, including intensity, frequency, and duration, and metrics for tracking improvement. Additionally, they provide a detailed overview of all things related to magnesium supplementation. The two conclude with insights about how to effectively engage with your doctor in the pursuit of getting your questions answered and considerations for finding a physician that?s right for you.

If you?re not a subscriber and listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #19 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Defining zone 2 exercise (3:30); The most effective ways to engage in zone 2 exercise (14:00); The process of training a deconditioned individual with zone 2: Dosage, frequency, and metrics to watch (19:45); Training for health vs. performance, and the importance dedicating training time solely to zone 2 (25:00); Why Peter does his zone 2 training in a fasted state (31:30); Improving mitochondrial density and function with zone 2 training (34:00); Metrics to monitor improving fitness levels from zone 2 training (36:30); Advice for choosing a bicycle for zone 2 exercise at home (42:30); Comparing the various equipment options for aerobic training: Rowing machine, treadmill, stairmaster, and more [48:15]; Back pain and exercise, and Peter?s stability issues as a consequence of previous surgeries (51:45); A deep dive into magnesium supplementation, and Peter?s personal protocol (55:30); Advice for engaging with and questioning your doctor (1:03:15); and More.

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/ama19

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2021-01-18
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#144 - Phil Maffetone: Optimizing health and performance through maximal aerobic function

Phil Maffetone is an author, health practitioner, and coach with decades of experience helping everyone from amateurs to world-class athletes optimize their health and performance. In this episode, Phil explains the importance of developing the aerobic system, defines maximum aerobic function (MAF), and explains how to determine your MAF heart rate. He then demonstrates how to integrate that into a training protocol which is designed to help people move faster at a sub maximum heart rate and increase fat utilization as the primary source of fuel?emphasizing the importance of nutrition on one's capacity to oxidize fat. Phil also extracts training insights from the amazing feats of world-class marathoners, explores the impact of a low-carb diet on one?s capacity for high intensity exercise and anaerobic performance, and explains the downstream effects of being ?overfat.?

 

We discuss:

 

Phil?s background in running, and training insights from a six-day race (2:30); The difference between being ?fit? and being ?healthy? (11:00); Defining the aerobic and anaerobic systems, and why VO2 max doesn?t predict performance (18:15); Defining maximum aerobic function (MAF), determining your MAF heart rate with Phil?s 180 Formula, and why a strong aerobic system is crucial to health and performance (24:00); Using the MAF test to track and improve your aerobic fitness (37:30); How increasing your sub-max pace at a given heart rate can increase your maximum pace (40:00); The impact of nutrition on one?s ability to use fat as fuel while exercising (43:00); Phil?s nutritional approach with patients, the concept of ?carbohydrate intolerance? (51:45); Assessing the impact of a low-carb diet on high intensity exercise and anaerobic performance (58:00); Extracting insights from world-class marathoners (1:04:45); How being ?overfat? affects health and performance, and ways to decrease excess body fat (1:13:30); and More.

Learn more: https://peterattiamd.com/

Show notes page for this episode: http://peterattiamd.com/PhilMaffetone

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2021-01-11
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#143 - John Ioannidis, M.D., D.Sc.: Why most biomedical research is flawed, and how to improve it

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

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2021-01-04
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#142 - Robert Abbott: The Bobby Knight story?a cautionary tale of unchecked anger, ego, and winning at all costs

Robert Abbott is a six-time Emmy award winner and the director of ?The Last Days of Knight,? the behind-the-scenes documentary of legendary coach Bobby Knight, and the events that led to his termination from Indiana University. In this episode, Robert takes us through his investigative journey, which revealed cautionary tales of a winning at all costs environment?how pain often gets left in the wake of unchecked anger, ego, and perfectionism. Robert reflects on Knight?s legacy and extracts lessons in self-awareness and accountability that can be applied to ensure history doesn?t repeat itself.


We discuss:

Robert?s career covering sports and interesting athletes (2:30); Robert?s early impression of Bobby Knight?s controversial persona (10:15); The journalistic work that uniquely prepared Robert for his Bobby Knight story (13:30); The cost of excellence in sports?cautionary tales of ?greatness at any cost? (19:15); Knight?s coaching style, waning success in the 90s, and what put him on Robert?s radar (25:30); Three alarming accounts from a former player (Neil Reed) that launched Robert?s investigation into Bobby Knight (35:15); The ?win-first? environment at Indiana that provided cover for Knight?s toxic behavior (44:45); Knight?s ego swells?a shift from team-first to ?I? and ?me? (53:00); How patience, honesty, and gaining trust with his sources paid off in his reporting on Bobby Knight (1:01:30); The vicious cycle and anger and shame, and why Bobby Knight is so interesting to Peter (1:08:00); Releasing the choking tape?Breaking open the Knight story, vindicating his earlier reporting, and the most powerful moment Robert has ever witnessed in his journalistic career (1:20:00); The bittersweet story of Neil Reed?triumph, PTSD, and breaking the cycle of pain (1:43:15); Examining Bobby Knight's legacy, and how society can avoid a repeat of similar devastating situations (1:57:30); Final thoughts on Bobby Knight and the pain left in his wake (2:08:00); and More.

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2020-12-21
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#141 - AMA #18: Deep dive: sugar and sugar substitutes

In this ?Ask Me Anything? (AMA) episode, Peter and Bob talk all about sugar and sugar substitutes and provide a way to think about sugar consumption. The conversation begins by defining the various forms of sugar, delineating between added sugar and naturally occurring sugar, and describing the important variables that determine the potential for metabolic damage from consumption. They then take a dive deep into three main categories of sugar substitutes?non-nutritive sweeteners, alcohol sugars, and leaving allulose, in a class by itself?including the safety profile of each, impact on blood sugar and insulin, side-effects, taste preferences, and more. 

If you?re not a subscriber and listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #18 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here

We discuss:

Delineating the various forms of ?sugar? (2:00); Added sugar vs. naturally occurring sugar (12:30); Important variables related to sugar consumption: Density, volume, and velocity (17:00); Alternatives to sugar: Non-nutritive sweeteners (22:30); Alternatives to sugar: Alcohol sugars (34:15); Alternatives to sugar: Allulose (39:00); Contextualizing risk when it comes to sugar substitutes (45:00); Why some people report feeling better when eliminating non-nutritive sweeteners from their diet (46:30); The impact of sweetness?Cephalic insulin response and the metabolic drive to eat more (49:45); and More.

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Show notes page for this episode: https://peterattiamd.com/ama18/ 

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2020-12-14
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#140 - Gerald Shulman, M.D., Ph.D.: A masterclass on insulin resistance?molecular mechanisms and clinical implications

Gerald Shulman is a Professor of Medicine, Cellular & Molecular Physiology, and the Director of the Diabetes Research Center at Yale. His pioneering work on the use of advanced technologies to analyze metabolic flux within cells has greatly contributed to the understanding of insulin resistance and type 2 diabetes. In this episode, Gerald clarifies what insulin resistance means as it relates to the muscle and the liver, and the evolutionary reason for its existence. He goes into depth on mechanisms that lead to and resolve insulin resistance, like the role of diet, exercise, and pharmacological agents. As a bonus, Gerald concludes with insights into Metformin?s mechanism of action and its suitability as a longevity agent.

We discuss:

Gerald?s background and interest in metabolism and insulin resistance (4:30); Insulin resistance as a root cause of chronic disease (8:30); How Gerald uses NMR to see inside cells (12:00); Defining and diagnosing insulin resistance and type 2 diabetes (19:15); The role of lipids in insulin resistance (31:15); Confirmation of glucose transport as the root problem in lipid-induced insulin resistance (40:15); The role of exercise in protecting against insulin resistance and fatty liver (50:00); Insulin resistance in the liver (1:07:00); The evolutionary explanation for insulin resistance?an important tool for surviving starvation (1:17:15); The critical role of gluconeogenesis, and how it?s regulated by insulin (1:22:30); Inflammation and body fat as contributing factors to insulin resistance (1:32:15); Treatment approaches for fatty liver and insulin resistance, and an exciting new pharmacological approach (1:41:15); Metformin?s mechanism of action and its suitability as a longevity agent (1:58:15); More.

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Show notes page for this episode:  https://peterattiamd.com/geraldshulman 

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2020-12-07
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#139 - Kristin Neff, Ph.D.: The power of self-compassion

Kristin Neff is a Professor of Educational Psychology at the University of Texas, author, and a leading expert on mindful self-compassion. In this episode, she shares how developing a self-compassion and mindfulness practice was the most effective tool for relieving her own suffering, and provides strategies and tactics to improve self-compassion and well-being.

We discuss:

The life crisis that turned Kristin to mindfulness and self-compassion (3:30); How mindful self-compassion relieved Kristin?s feelings of self-judgement, and the psychology that says we all have the capacity for self-compassion (9:45); Peter?s history of self-criticism and his personal practice of self-compassion (17:15); The problem with prioritizing self-esteem over self-compassion, and how self-compassion produces a more stable version of self-worth (20:15); An argument for self-compassion over self-criticism for optimizing performance (26:15); How and when to introduce self-compassion to children (31:45); Learning her son had autism?a personal story of how Kristin used mindfulness and self-compassion (36:45); Self-compassion for cases of childhood trauma, PTSD, and overcoming a ?fear of compassion? (44:00); The relationship between self-compassion and physical health (49:30); Distinguishing between self-compassion and self-pity, and the three necessary components self-compassion (52:30); Why self-criticism comes from a desire to be safe, the circular pattern of self-judgment, and self-compassion as the ultimate motivator (55:45); Potential role of a self-compassion practice for addiction and other maladaptive behaviors (58:45); Clinical applications and practical uses of self-compassion (1:01:30); Why you don?t need to meditate to learn mindfulness and self-compassion (1:04:45); Kristin?s personal meditation practice (1:08:40); Resources for learning self-compassion (1:11:45); and More.

Learn more: https://peterattiamd.com/

Show notes page for this episode:  https://peterattiamd.com/kristinneff 

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2020-11-30
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#138 - Lauren Miller Rogen and Richard Isaacson, M.D.: Alzheimer?s disease prevention?patient and doctor perspectives

Peter is joined by writer, director, actress, and founder of HFC, Lauren Miller Rogen, and previous podcast guest and director of the Alzheimer?s Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian, Dr. Richard Isaacson. In this episode, Lauren tells the heartbreaking story of watching members of her family succumb to Alzheimer?s disease (AD) which motivated her to proactively address her own risk with Richard?s guidance. Richard discusses the various genetic and lifestyle factors that influence the risk of AD and uses Lauren?s unique situation to explain how he diagnoses patients and personalizes care. They go through Lauren?s protocol of preventative measures that have already produced marked results, and end with the uplifting message that one?s genetic predisposition does not seal one's fate.

We discuss:

Lauren?s deep family history of Alzheimer?s disease (3:10); The influence of genetics, epigenetics, and lifestyle on Alzheimer?s disease risk (13:45); Lauren?s mother?s disease progression and the enormous stress it causes for family members (24:30); The various manifestations of Alzheimer?s disease depending on the location of pathology (29:30); The three stages of Alzheimer's disease (34:45); Richard?s deep exploration into Lauren?s family history revealing clues about a diagnosis and a roadmap to successful disease mitigation (39:15); How exercise reduces Alzheimer?s disease risk, and the different risk between males and females (58:00); Why knowing your APOE status is important, and whether certain people should be wearier of head trauma (1:08:00); How Richard uses genetic testing to personalize care (1:14:45); The ?ABCs? of Alzheimer?s prevention, lifestyle interventions, and Lauren?s personal protocol for reducing her risk (1:21:45); Unique treatment for people with the ApoE4 variant (1:36:30); Richard?s mixed opinion on CBD and THC as a tool for disease prevention (1:40:00); Cognitive testing procedures, and how Lauren?s tests furthered her commitment to her disease prevention protocol (1:41:45); The relevance of sense of smell and hearing in Alzheimer?s disease risk and prevention (1:50:00); The emotional benefit of knowing you have control over your mental and physical health (1:57:30); HFC?a charitable organization founded by Lauren and Seth (2:00:15); and More.

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Show notes page for this episode: https://peterattiamd.com/laurenmillerrogen-richardisaacson/ 

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2020-11-23
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