View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Eric Ravussin is a world-renowned expert on obesity, metabolism, and aging whose pioneering research has shaped much of what we understand today about energy balance and caloric restriction. In this episode, Eric shares insights from his cutting-edge work on energy expenditure—a critical factor in understanding how our bodies regulate weight and appetite. He discusses methods for measuring energy output, energy balance, food intake, and appetite regulation, and explores key studies on macronutrient manipulation. Eric then delves into the CALERIE study on caloric restriction, highlighting insights related to biomarkers of both primary and secondary aging. The conversation also covers the potential of GLP-1 agonists to replicate these effects and looks ahead to how AI and technology could transform metabolic research in the coming years. We discuss: Eric’s background and current work metabolism and measuring energy expenditure [3:00]; The science behind metabolic chambers for measuring energy expenditure, and the complexities of indirect and direct calorimetry [8:00]; The body's regulatory systems for maintaining energy balance and the primary influence of energy intake on body weight [18:30]; The epidemic of obesity and a discussion of resting metabolic rate [24:45]; The impact of exercise, appetite, gut hormones, and eating patterns on weight regulation [28:45]; Experiments looking at how macronutrient composition affects energy expenditure [38:45]; The challenges of studying diet in real-life settings, the potential of personalized nutrition, and how public health policy could play a role in guiding nutritional habits [51:00]; The importance of protein in the diet, the limitations of dietary data collection, and how AI could potentially transform nutrition science [1:08:15]; How Eric’s interest in caloric restriction (CR) began with Biosphere 2, metabolic efficiency's role in aging, and goals of the CALERIE study [1:15:15]; The CALERIE study: exploring the real-world impact of caloric restriction [1:28:00]; Notable findings from the CALERIE study after two years: sustained weight loss, participant retention, and more [1:40:00]; The effect of caloric restriction on the hallmarks of aging [1:47:00]; The challenge of applying CR to the general population, the potential of drugs and exercise to mimic the effects of CR [1:55:45]; Upcoming study comparing caloric restriction to time-restricting eating, and Peter’s takeaways from the discussion [2:02:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Feng Zhang, a professor of neuroscience at MIT and a pioneering figure in gene editing, joins Peter to discuss his groundbreaking work in CRISPR technology, as well as his early contributions to optogenetics. In this episode, they explore the origins of CRISPR and the revolutionary advancements that have transformed the field of gene editing. Feng delves into the practical applications of CRISPR for treating genetic diseases, the importance of delivery methods, and the current successes and challenges in targeting cells specific tissues such as those in the liver and eye. He also covers the ethical implications of gene editing, including the debate around germline modification, as well as reflections on Feng’s personal journey, the impact of mentorship, and the future potential of genetic medicine. We discuss: Feng’s background, experience in developing optogenetics, and his shift toward improving gene-editing technologies [2:45]; The discovery of CRISPR in bacterial DNA and the realization that these sequences could be harnessed for gene editing [10:45]; How the CRISPR system fights off viral infections and the role of the Cas9 enzyme and PAM sequence [21:00]; The limitations of earlier gene-editing technologies prior to CRISPR [28:15]; How CRISPR revolutionized the field of gene editing, potential applications, and ongoing challenges [36:45]; CRISPR’s potential in treating genetic diseases and the challenges of effective delivery [48:00]; How CRISPR is used to treat sickle cell anemia [53:15]; Gene editing with base editing, the role of AI in protein engineering, and challenges of delivery to the right cells [1:00:15]; How CRISPR is advancing scientific research by fast-tracking the development of transgenic mice [1:06:45]; Advantages of Cas13’s ability to direct CRISPR to cleave RNA and the advances and remaining challenges of delivery [1:11:00]; CRISPR-Cas9: therapeutic applications in the liver and the eye [1:19:45]; The ethical implications of gene editing, the debate around germline modification, regulation, and more [1:30:45]; Genetic engineering to enhance human traits: challenges, trade-offs, and ethical concerns [1:40:45]; Feng’s early life, the influence of the American education system, and the critical role teachers played in shaping his desire to explore gene-editing technology [1:46:00]; Feng’s optimism about the trajectory of science [1:58:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Belinda Beck, founder of The Bone Clinic and a leading authority on exercise physiology and bone health, delves into the science of osteoporosis, bone density, and the lifelong importance of maintaining skeletal health. In this episode, she explains how the foundation for strong bones is established during childhood, offering valuable advice for parents on optimizing bone health for their kids. She also explores how bone remodeling occurs throughout life, driven by activity, nutrition, and hormones. Belinda highlights the power of resistance training in improving bone strength, even for those at risk of bone loss, and emphasizes the role of essential vitamins and minerals in maintaining bone health. She shares practical strategies, backed by research, for preventing fractures and combating osteoporosis. We discuss: Belinda’s journey into bone health research and training [2:45]; The physiology of bone and how bones adapt to mechanical loading [8:15]; Bone development from birth to adulthood, why early life is a crucial period, the functions of osteoblasts and osteoclasts, and gender differences in BMD [14:00]; How parents can optimize their children’s bone health through diet (calcium and vitamin D), sunlight exposure, and physical activity [27:30]; The best sports and activities for promoting bone health, weight training for kids, and advice for parents [36:30]; The impact of corticosteroid use on bone health in children and strategies to minimize negative effects [48:30]; Advice for people in middle age to preserve bone density: physical activity and bone-loading exercises [52:00]; Bone loss during the menopause transition for women: hormone replacement therapy and other strategies to mitigate BMD losses [59:30]; Interpreting the bone mineral density results from a DEXA scan: T-score, Z-score, and more [1:03:00]; The LIFTMOR study: testing the effects of heavy weightlifting on bone health in postmenopausal women with low bone density [1:10:15]; Profound benefits of weight training outside of BMD improvements: exploring the broader impacts on patients in the LIFTMOR study [1:19:30]; Guidance for people wanting to use exercise designed to improve their bone health [1:29:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Anna Lembke is the Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic and author of Dopamine Nation: Finding Balance in the Age of Indulgence. In this episode, Anna dives deep into the biochemistry and neurobiology of addiction, exploring the critical role of dopamine and the prefrontal cortex. She shares her framework for diagnosing and treating addiction, providing real-world examples involving alcohol, gambling, cannabis, social media, and more. Anna outlines the risk factors for addiction, including inherited and nurture-based risks, explores the rise of addictions in younger generations, and discusses effective ways to address these issues with children. Additionally, she touches on healthy coping strategies, the evolution of the “marshmallow experiment,” and provides insights into GLP-1 agonists as a possible tool for addiction treatment. Finally, she reflects on the value of 12-step programs and how she navigates the emotional challenges of her work. We discuss: The role of dopamine and the prefrontal cortex in addiction [3:00]; The clinical definition of addiction and the behavioral criteria for diagnosing it [13:00]; Assessing alcohol use: patterns, risks, and addiction diagnosis [17:15]; Applying the addiction diagnosis framework using gambling as an example [21:45]; Exploring addiction variability: how nature, nurture, and access shape individual vulnerability and drug of choice [25:15]; How abstinence from addictive behaviors can help reset the brain’s reward system and improve mental health [41:15]; Safely abstaining from addiction substances, drugs needing medical supervision, and other key considerations [51:30]; Transitioning from abstinence to long-term recovery: tools and considerations [59:00]; Exploring behavioral addictions like sex addiction, and the gender differences in addiction patterns [1:08:30]; Factors contributing to the increasing levels of addiction across the world [1:13:45]; How online pornography can affect young boys' developing brains and lead to addictive behaviors, and strategies for parents to address this issue [1:23:30]; The link between social media use and declines in mental health, potential solutions, and protective measures [1:34:45]; How exercise affects brain chemistry, the role of dopamine and endorphins, and how exercise can become addictive [1:44:00]; Cold-water immersion for mood regulation, and other healthy coping strategies [1:47:15]; The “marshmallow experiment”: how broken promises affect behavior and trustworthy environments help children develop self-control [1:54:00]; Can GLP-1 agonists be useful in treating addiction? [1:58:30]; The benefits of 12-step programs [2:06:00]; Why understanding a patient’s story is essential for meaningful psychiatric care [2:11:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter dives back into the increasingly popular topic of GLP-1 agonists, such as Ozempic and Mounjaro, which have garnered widespread attention for their ability to promote weight loss. Peter covers the latest findings in this rapidly evolving landscape, including new insights into their long-term efficacy, side effects, and what happens when the drug is discontinued. Peter also explores their impact on body composition and how resistance training interacts with these treatments. Additionally, he compares different GLP-1 receptor agonists and discusses promising new drugs in the pipeline. Finally, Peter addresses questions about the role of compounding pharmacies in the GLP-1 agonist market, compares oral vs. injectable options, and provides key considerations for anyone deciding whether to use a GLP-1 agonist for weight loss. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #64 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: The rapidly evolving landscape of GLP-1 agonists [2:15]; The mechanism of GLP-1 agonists, their origin as diabetes treatments, and how they evolved into weight-loss drugs [6:45]; Overview of new data and open questions related to the benefits and risks of GLP-1 agonists [10:30]; New insights into the long-term safety of GLP-1 agonists, side effects, and more [16:45]; The long-term efficacy of GLP-1 agonists, financial barriers, and more [19:45]; The mechanisms behind GLP-1 agonists' ability to promote weight loss [22:00]; New data on body weight changes after discontinuing the drug [26:00]; Effects of GLP-1 agonists on lean mass and body composition, and the role of protein and resistance training in preserving muscle [31:30]; Semaglutide vs. tirzepatide: comparing benefits and side effects [36:30]; How compounding pharmacies affect availability of GLP-1 drugs and the types of formulations that are available [39:15]; How do oral formulations of GLP-1 drugs compare to injectable formulations? [44:15]; How do sublingual (under tongue) formulations of GLP-1 drugs compare to injectable formulations? [46:15]; Guidance for using compounding pharmacies to purchase GLP-1 agonists [47:15]; Data on retatrutide—a promising new triple receptor agonist in the pipeline [50:15]; Can GLP-1 agonists be beneficial for sleep apnea and immune function? [57:00]; Potential neuroprotective benefits of GLP-1 agonists: impact on dementia risk [1:00:45]; Exploring why GLP-1 agonists may reduce the risk of cancer, kidney disease, and cardiovascular disease [1:04:00]; How GLP-1 agonists might boost fertility in women [1:10:15]; Early indications that GLP-1 agonists may help treat substance abuse disorders [1:12:00]; Potential health risks of GLP-1 agonists: addressing thyroid cancer concerns and the unknowns due to lack of data [1:14:00]; Examining the potential link between GLP-1 agonists and increased depression or suicidal ideation [1:16:00]; Major remaining questions: the effects of cyclic use, rebound appetite, impact on adolescents' development, and more [1:19:30]; Key considerations when deciding whether to use a GLP-1 agonist for weight loss [1:23:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this quarterly podcast summary (QPS) episode, Peter summarizes his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from each episode, covering diverse topics such as liver health with Julia Wattacheril, heart rate variability with Joel Jamieson, artificial intelligence with Zak Kohane, klotho for brain health with Dena Dubal, and lactate and lactate metabolism with George Brooks. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these engaging discussions. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the episode #319 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Overview of topics, and the positive feedback on the quarterly podcast summary format [2:00]; Julia Wattacheril episode: liver health and disease [4:00]; Noninvasive methods to diagnose liver conditions, and how to manage and improve liver health [16:00]; Joel Jamieson episode: heart rate variability (HRV) for training and health [27:15]; Practical tools for measuring HRV and how it informs training and recovery decisions [37:00]; Zak Kohane episode: artificial intelligence and medicine [47:15]; The current role of AI in medicine and how it could revolutionize medicine in the future [53:45]; The limitations and concerns pertaining to AI [1:00:15]; Dena Dubal episode: the potential benefits of klotho for brain health [1:05:00]; Animal studies on klotho and brain health [1:11:00]; Genetics-based variations in klotho levels in humans and their impact on cognition, disease risk, and longevity [1:14:15]; Testing klotho levels, the significance of the KL-VS variant, the role of exercise in increasing klotho, and more [1:17:30]; The potential of klotho as a treatment for cognitive decline and Alzheimer's disease [1:23:15]; George Brooks episode: a new paradigm to think about lactate and lactate metabolism [1:27:45]; The potential for lactate infusions to aid in brain recovery following a head injury [1:34:00]; The relationship between lactate and cancer, and the impact of exercise on lactate levels and cancer risk [1:36:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Tadej Pogačar is a three-time Tour de France champion and one of the most dominant cyclists of his generation. In this episode, he shares insights into his 2020 Tour de France victory, his historic 2024 season winning both the Giro d’Italia and Tour de France, and the struggles he faced in 2022 and 2023. He also dives into his training regimen, nutrition, and the key metrics he tracks, like power, VAM, and heart rate variability. Tadej offers a glimpse into his goals for the future and what it takes to stay at the top of the sport. We discuss: 2020 Tour de France win [4:30]; Learning from previous mistakes [8:45]; Training: simulating steep climbs and other challenging race conditions [10:30]; Tadej’s historic 2024 season and what contributed to his success [12:30]; Nutrition for optimal performance: offseason diet and carbohydrate intake during intense training sessions [15:30]; Training metrics: heart rate, power output, VAM, and HRV, and his approach to zone 2 training [18:15]; Epic climbs in the Tour de France, mindset after challenging stages, and rebuilding confidence after the 2023 Tour [25:45]; Racing dynamics, media criticism, and Tadej’s reflections on racing records [32:15]; Training in the off-season [39:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Marty Makary, a Johns Hopkins surgeon and New York Times bestselling author, returns to The Drive to discuss his latest book, Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health. In this episode, Marty explores how a new generation of doctors is challenging long-held medical practices by asking critical new questions. He discusses the major problems of groupthink and cognitive dissonance in the medical community and delves into several of the "blind spots" raised in the book, including treatments for appendicitis, the peanut allergy epidemic, misunderstandings about HRT and breast cancer, antibiotic use, and the evolution of childbirth. He explains the urgent need for reform in medical education and the major barriers standing in the way of innovative medical research. Throughout the conversation, Marty offers insightful reflections on where medicine has succeeded and where there’s still room to challenge historic practices and embrace new approaches. We discuss: The issue of groupthink and cognitive dissonance in science and medicine [2:30]; How a non-operative treatment for appendicitis sheds light on cognitive dissonance [7:00]; How cognitive dissonance and effort justification shape beliefs and actions [13:15]; How misguided peanut allergy recommendations created an epidemic [17:45]; The enduring impact of misinformation and fear-based messaging around hormone replacement therapy allegedly causing breast cancer [25:15]; The dangers of extreme skepticism and blind faith in science, and the importance of understanding uncertainty and probability [28:00]; The overuse of antibiotics and the rise of antibiotic resistant infections and poor gut health [33:45]; The potential correlations between early antibiotic use and chronic diseases [40:45]; The historical and evolving trends in childbirth and C-section rates [50:15]; Rethinking ovarian cancer: recent data challenging decades of medical practice and leading to new preventive measures [1:05:30]; Navigating uncertainty as a physician [1:19:30]; The urgent need for reform in medical education [1:21:45]; The major barriers to innovative medical research [1:27:30]; The dogmatic culture of academic medicine: why humility and challenging established norms are key for progress [1:38:15]; The major successes and ongoing challenges of modern medicine [1:51:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of hair loss, exploring its relationship with aging and its impact on quality of life. The conversation focuses on androgenic alopecia, the most common form of hair loss in both men and women, and covers the differences in patterns and causes between the sexes. Peter delves into the right timing for treatment, breaking down various options such as minoxidil and finasteride, low-level laser therapy, platelet-rich plasma injections, and more. Additionally, Peter outlines the pros and cons of the two primary hair transplantation methods and concludes with practical advice on selecting the right specialist or treatment team for those facing hair loss. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #63 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: The impact of hair loss on emotional health [2:15]; The prevalence, patterns, and causes of hair loss in men and women [5:15]; The genetic and hormonal causes of hair loss, and the role of dihydrotestosterone (DHT) in androgenic alopecia [8:45]; The visual differences in hair loss patterns between men and women, and the importance of consulting a specialist to rule out non-genetic causes of hair loss [13:30]; How genetic predisposition influences the risk of androgenic alopecia, and how early detection through diagnostic tools and blood tests can help manage risk more effectively [16:45]; Ideal timing for starting treatment: why early treatment is crucial for effectively managing hair loss [19:30]; The various FDA-approved treatments for androgenic alopecia, their mechanisms, and additional off-label treatments commonly used to manage hair loss [24:30]; Topical minoxidil—the most commonly recommended starting treatment for hair loss [30:15]; Oral vs. topical minoxidil: efficacy, ease of use, and potential side effects that must be considered [33:45]; Finasteride for treating hair loss: efficacy, potential side effects on libido, and the need for careful PSA monitoring in men to avoid missing early signs of prostate cancer [37:15]; Other effective hair loss treatments for women: boosting hair density with spironolactone gel and ketoconazole shampoo as part of a comprehensive strategy [41:30]; Low-level laser therapy: effectiveness, costs, practicality, and a comparison of in-office treatments with at-home devices [49:00]; Platelet-rich plasma (PRP) as a treatment for hair loss: potential effectiveness, varying protocols, and significant costs [53:45]; Hair transplant for advanced hair loss: criteria and considerations [58:00]; Types of hair transplants: follicular unit transplantation (FUT) vs. follicular unit extraction (FUE) [1:02:00]; The financial cost of hair transplant surgery, and what to consider when seeking affordable options [1:06:15]; The potential risks and downsides of the various hair transplant procedures [1:09:30]; Post-procedure care for hair transplants and whether the procedure must be repeated periodically [1:16:30]; Combining different hair loss treatments: benefits, risks, and considerations [1:18:30]; Emerging hair loss treatments with limited data [1:21:00]; Key considerations for selecting the right treatment plan for hair loss [1:22:00]; A summary of the different considerations for men and women facing hair loss [1:24:30]; Practical advice on selecting the right specialist or treatment team [1:26:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this episode, former World Series of Poker champion and author Annie Duke explains how poker is a pertinent model system for decision-making in the real world, a system which blends imperfect information with some unknown percentage of both luck and skill. Annie breaks down the decision-making matrix, revealing how we often focus too narrowly on just one of the four quadrants, missing out on valuable learning opportunities in the remaining 75% of situations. She delves into how our tendency to evaluate only negative outcomes leads to a culture of risk aversion. This mindset, she argues, stifles the kind of bold decision-making necessary for progress and innovation across various fields, from poker and sports to business and medicine. Annie also introduces a robust framework for learning and the levels of thought required to excel in any domain. Finally, she discusses a strategy called “backcasting”, a concept that resonated deeply with Peter in terms of how he thinks about extending healthspan. We discuss: Annie’s background, favorite sports teams, and Peter’s affinity for Bill Belichick [1:30]; Chess vs. poker: Which is a better metaphor for decision-making in life (and medicine)? [6:45]; Thinking probabilistically: Why we aren’t wired that way, and how you can improve it for better decision-making [12:30]; Variable reinforcement: The psychological draw of poker that keeps people playing [19:15]; The role of luck and skill in poker (and other sports), and the difference between looking at the short run vs. long run [32:15]; A brief explanation of Texas hold ‘em [41:00]; The added complexity of reading the behavior of others players in poker [47:30]; Why Annie likes to “quit fast,” and why poker is still popular despite the power of loss aversion [52:45]; Limit vs. no-limit poker, and how the game has changed with growing popularity [55:15]; The advent of analytics to poker, and why Annie would get crushed against today’s professionals [1:04:45]; The decision matrix, and the “resulting” heuristic: The simplifier we use to judge the quality of decisions —The Pete Carroll Superbowl play call example [1:10:30]; The personal and societal consequences of avoiding bad outcomes [1:21:45]; Poker as a model system for life [1:31:30]; How many leaders are making (and encouraging) status-quo decisions, and how Bill Belichick’s decision-making changed after winning two Super Bowls [1:35:15]; What did we learn about decision-making from the Y2K nothingburger? And how about the D-Day invasion? [1:39:30]; The first step to becoming a good decision maker [1:43:00]; The difference between elite poker players and the ones who make much slower progress [1:49:45]; Framework for learning a skill, the four levels of thought, and why we hate digging into our victories to see what happened [1:52:15]; The capacity for self-deception, and when it is MOST important to apply four-level thinking [2:00:30]; Soft landings: The challenge of high-level thinking where there is subtle feedback and wider skill gaps [2:11:00]; The benefits of “backcasting” (and doing pre-mortems) [2:13:30]; Parting advice from Annie for those feeling overwhelmed (and two book recommendations) [2:21:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Sebastian Junger is an award-winning journalist, bestselling author, and previous guest on The Drive. In this episode, Sebastian returns to discuss his latest book, In My Time of Dying: How I Came Face to Face with the Idea of an Afterlife. This episode delves into Sebastian's profound near-death experience and how it became the catalyst for his exploration of mortality, the afterlife, and the mysteries of the universe. They discuss the secular meaning of what it means to be sacred, the intersection of physics and philosophy, and how our beliefs shape our approach to life and death. He also shares how this experience has profoundly changed him, giving him a renewed perspective on life—one filled with awe, gratitude, deeper emotional awareness, and a more engaged approach to living. We discuss: How Sebastian’s near-death experience shaped his thinking about mortality and gave him a reverence for life [3:00]; The aneurysm that led to Sebastian’s near-death experience [6:30]; Emergency room response, his subsequent reflections on the event, and the critical decisions made by the medical team [16:30]; Sebastian’s reaction to first learning he nearly died, and the extraordinary skill of the medical team that save his life [26:00]; Sebastian’s near-death experience [37:00]; The psychological impact of surviving against overwhelming odds [48:00]; Ignored warning signs: abdominal pain and a foreshadowing dream before the aneurysm rupture [54:30]; Sebastian's recovery, his exploration of near-death experiences, and the psychological turmoil he faced as he questioned the reality of his survival [58:15]; A transformative encounter with a nurse who encouraged Sebastian to view his near-death experience as sacred [1:03:30]; How Sebastian has changed: a journey toward emotional awareness and fully engaging with life [1:08:45]; The possibility of an afterlife, and how quantum mechanics challenges our understanding of existence [1:15:15]; Quantum paradoxes leading to philosophical questions about the nature of reality, existence after death, and whether complete knowledge could be destructive [1:26:00]; The sweet spot of uncertainty: exploring belief in God, post-death existence, and meaning in life [1:37:00]; The transformative power of experiencing life with awe and gratitude [1:53:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter David Allison, a leading expert in obesity and nutrition, quantitative genetics, clinical trials, and research methodology, returns to The Drive to explore the evolving landscape of nutrition science and obesity treatment. In this episode, David begins by discussing the intricate relationship between nutrition, obesity, and body composition, emphasizing the multifaceted impacts of food beyond mere calorie intake. David provides a critical analysis of the complexities in nutrition research and their practical implications for tackling obesity. He critiques historical public health policies, addresses the trust issues plaguing nutrition science, and underscores the need for a paradigm shift to more effectively combat obesity. The conversation also delves into the rise of GLP-1 receptor agonists like Ozempic and Mounjaro, exploring their ethical and practical considerations in obesity treatment. The episode concludes with an in-depth look at protein intake recommendations and highlights the significant research gaps that remain in the field. We discuss: The complex relationship between nutrition, body weight, and body composition [2:30]; The slow progress in addressing obesity and public health despite substantial effort and investment [7:30]; The very limited success of public health initiatives in curbing obesity [17:15]; The evolving landscape of obesity research: public health initiatives and the impact of pharmacological success [26:30]; Rethinking obesity solutions: the need for a paradigm shift [32:45]; Understanding environmental triggers and embracing a balanced approach to addressing obesity that includes both pharmacological treatments and realistic lifestyle changes [41:45]; The need for higher standards in obesity research [51:45]; The rapid success of GLP-1 receptor agonists for weight loss: a discussion on the societal impact and controversy of their growing usage [1:02:15]; The ethical and practical considerations of obesity drugs: risks, benefits, and motivations for usage [1:11:30]; The use of GLP-1 agonists by athletes as performance enhancers [1:23:45]; Unanswered questions about protein intake and health [1:30:45]; Future research needed to understand basic questions around protein intake [1:45:00]; David’s weekly newsletter: “Obesity and Energetics Offerings” [1:50:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter dives into two important health topics: uric acid and protein, examining them from unique perspectives. For uric acid, he explores its metabolic role and connection to various diseases, focusing on the potential causal link with cardiovascular disease. He also discusses factors influencing uric acid levels, such as diet, genetics, and lifestyle, providing practical tips for effective management. Shifting to protein, Peter delves into its role in appetite and weight management, the consequences of insufficient protein, and the “protein leverage hypothesis” linking protein deficiency to obesity. He covers optimal protein intake and its impact on energy expenditure, and he compares the satiety effects of solid versus liquid protein. Finally, Peter shares his strategy for incorporating protein into a comprehensive weight management plan. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #62 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Overview of episode topics (and an important discussion on fanny packs) [2:00]; Understanding uric acid: its role in metabolic processes, its association with gout and kidney stones, its impact on blood pressure, and more [6:00]; Non-modifiable factors that influence uric acid levels [11:00]; Modifiable factors that influence uric acid levels [14:15]; Association between high uric acid levels and cardiovascular disease [20:00]; Evidence suggesting a causal link between high uric acid levels and cardiovascular disease [24:00]; Inconclusive evidence about the cardiovascular benefits of lowering uric acid pharmacologically [28:15]; Exploring the potential risks of low uric acid levels in neurodegenerative diseases [37:00]; Managing uric acid levels: dietary interventions and pharmacological approaches [42:00]; The impact of protein on appetite and weight management [44:00]; The consequences of insufficient protein on eating behaviors and satiety [52:15]; The relationship between protein deficiency and obesity: exploring the “protein leverage hypothesis” [57:15]; The impact of protein intake on energy expenditure [1:02:15]; Determining optimal protein intake to avoid deficiency and support health [1:05:45]; The role of different amino acids and protein sources in promoting satiety [1:08:15]; Comparing the satiety effects of solid vs. liquid protein sources [1:10:30]; Peter’s framework for incorporating protein intake into a strategy for controlling body weight [1:12:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter George A. Brooks is a renowned professor of integrative biology at UC Berkeley. Known for his groundbreaking "lactate shuttle" theory proposed in the 1980s, George revolutionized our understanding of lactate as a crucial fuel source rather than just a byproduct of exercise. In this episode, George clarifies common misconceptions between lactate and lactic acid, delves into historical perspectives, and explains how lactate serves as a fuel for the brain and muscles. He explores the metabolic differences in exceptional athletes and how training impacts lactate flux and utilization. Furthermore, George reveals the significance of lactate in type 2 diabetes, cancer, and brain injuries, highlighting its therapeutic potential. This in-depth conversation discusses everything from the fundamentals of metabolism to the latest research on lactate's role in gene expression and therapeutic applications. We discuss: Our historical understanding of lactate and muscle metabolism: early misconceptions and key discoveries [3:30]; Fundamentals of metabolism: how glucose is metabolized to produce ATP and fuel our bodies [16:15]; The critical role of lactate in energy production within muscles [24:00]; Lactate as a preferred fuel during high-energy demands: impact on fat oxidation, implications for type 2 diabetes, and more [30:45]; How the infusion of lactate could aid recovery from traumatic brain injuries (TBI) [43:00]; The effects of exercise-induced lactate [49:30]; Metabolic differences between highly-trained athletes and insulin-resistant individuals [52:00]; How training enhances lactate utilization and facilitates lactate shuttling between fast-twitch and slow-twitch muscle fibers [58:45]; The growing recognition of lactate and monocarboxylate transporters (MCT) [1:06:00]; The intricate pathways of lactate metabolism: isotope tracer studies, how exceptional athletes are able to utilize more lactate, and more [1:09:00]; The role of lactate in cancer [1:23:15]; The role of lactate in the pathophysiology of various diseases, and how exercise could mitigate lactate's carcinogenic effects and support brain health [1:29:45]; George’s current research interests involving lactate [1:37:00]; Questions that remain about lactate: role in gene expression, therapeutic potential, difference between endogenous and exogenous lactate, and more [1:50:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this special episode, Peter provides a comprehensive introduction to longevity, perfect for newcomers or those looking to refresh their knowledge. He lays out the foundational concepts of lifespan, healthspan, and the marginal decade. Additionally, Peter discusses the four main causes of death and their prevention, as well as detailing the five key strategies in his longevity toolkit to improve lifespan and healthspan. Detailed show notes provide links for deeper exploration of these topics, making it an ideal starting point for anyone interested in understanding and improving their longevity. We discuss: Key points about starting exercise as an older adult [2:45]; Overview of episode topics and structure [1:45]; How Peter defines longevity [3:45]; Why healthspan is a crucial component of longevity [11:15]; The evolution of medicine from medicine 1.0 to 2.0, and the emergence of medicine 3.0 [15:30]; Overview of atherosclerotic diseases: the 3 pathways of ASCVD, preventative measures, and the impact of metabolic health [26:00]; Cancer: genetic and environmental factors, treatment options, and the importance of early and aggressive screening [33:15]; Neurodegenerative diseases: causes, prevention, and the role of genetics and metabolic health [39:30]; The spectrum of metabolic diseases [43:15]; Why it’s never too late to start thinking about longevity [44:15]; The 5 components of the longevity toolkit [46:30]; Peter’s framework for exercise—The Centenarian Decathlon [47:45]; Peter’s nutritional framework: energy balance, protein intake, and more [58:45]; Sleep: the vital role of sleep in longevity, and how to improve sleep habits [1:08:30]; Drugs and supplements: Peter’s framework for thinking about drugs and supplements as tools for enhancing longevity [1:13:30]; Why emotional health is a key component of longevity [1:17:00]; Advice for newcomers on where to start on their longevity journey [1:19:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Ted Schaeffer is an internationally recognized urologist specializing in prostate cancer and a returning guest on The Drive. In this episode, Ted provides insights into the role testosterone plays, or doesn't play, in the initiation and progression of prostate cancer. He unpacks the findings and limitations of the recent TRAVERSE trial, exploring the complex relationship between testosterone and prostate cancer. Ted delves into the molecular nature of prostate cancer, explaining the androgen receptor saturation theory and the potential impact of testosterone on cancer growth. He also discusses the use of the Decipher test to predict cancer aggressiveness and guide targeted treatment. Furthermore, Ted shares how he counsels patients regarding testosterone replacement therapy (TRT), including its safe administration in patients with low-grade prostate cancer. Additionally, he highlights advancements in prostate cancer therapies and biomarkers that help develop precise treatment strategies while minimizing the need for broad androgen deprivation therapy. We discuss: Background on the TRAVERSE trial: insights into exogenous testosterone and prostate cancer risk [3:00]; The androgen receptor saturation theory: how different organs respond to varying levels of testosterone [10:30]; The relationship between testosterone levels and prostate cancer aggressiveness: how aggressive prostate tumors have lower androgen receptor activity and rely on different growth mechanisms [16:15]; Using the Decipher score to assess prostate cancer aggressiveness and guide personalized treatment strategies [23:45]; Considerations for testosterone replacement therapy: how Ted counsels patients, how TRT can be safely administered in patients with low-grade prostate cancer, and more [31:15]; Advancements in prostate cancer therapies and PSA as a biomarker for precise treatment decisions, minimizing the need for broad androgen deprivation therapy [38:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Isaac "Zak" Kohane, a pioneering physician-scientist and chair of the Department of Biomedical Informatics at Harvard Medical School, has authored numerous papers and influential books on artificial intelligence (AI), including The AI Revolution in Medicine: GPT-4 and Beyond. In this episode, Zak explores the evolution of AI, from its early iterations to the current third generation, illuminating how it is transforming medicine today and unlocking astonishing possibilities for the future. He shares insights from his unconventional journey and early interactions with GPT-4, highlighting significant AI advancements in image-based medical specialties, early disease diagnosis, and the potential for autonomous robotic surgery. He also delves into the ethical concerns and regulatory challenges of AI, its potential to augment clinicians, and the broader implications of AI achieving human-like creativity and expertise. We discuss: Zak’s unconventional journey to becoming a pioneering physician-scientist, and his early interactions with GPT-4 [2:15]; The evolution of AI from the earliest versions to today’s neural networks, and the shifting definitions of intelligence over time [8:00]; How vast data sets, advanced neural networks, and powerful GPU technology have driven AI from its early limitations to achieving remarkable successes in medicine and other fields [19:00]; An AI breakthrough in medicine: the ability to accurately recognize retinopathy [29:00]; Third generation AI: how improvements in natural language processing significantly advanced AI capabilities [32:00]; AI concerns and regulation: misuse by individuals, military applications, displacement of jobs, and potential existential concerns [37:30]; How AI is enhancing image-based medical specialties like radiology [49:15]; The use of AI by patients and doctors [55:45]; The potential for AI to augment clinicians and address physician shortages [1:02:45]; The potential for AI to revolutionize early diagnosis and prediction of diseases: Alzheimer’s disease, CVD, autism, and more [1:08:00]; The future of AI in healthcare: integration of patient data, improved diagnostics, and the challenges of data accessibility and regulatory compliance [1:17:00]; The future of autonomous robotic surgery [1:25:00]; AI and the future of mental health care [1:31:30]; How AI may transform and disrupt the medical industry: new business models and potential resistance from established medical institutions [1:34:45]; Potential positive and negative impacts of AI outside of medicine over the next decade [1:38:30]; The implications of AI achieving a level of creativity and expertise comparable to exceptional human talents [1:42:00]; Digital immortality and legacy: the potential to emulate an individual's personality and responses and the ethical questions surrounding it [1:45:45]; Parting thoughts [1:50:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Iñigo San-Millán is an internationally renowned applied physiologist and a previous guest on The Drive. His research and clinical work focuses on exercise-related metabolism, metabolic health, diabetes, cancer metabolism, nutrition, sports performance, and critical care. In this episode, Iñigo describes how his work with Tour de France winner Tadej Pogačar has provided insights into the amazing potential of elite athletes from a performance and metabolic perspective. He speaks specifically about lactate levels, fat oxidation, how carbohydrates in food can affect our lactate and how equal lactate outputs between an athlete and a metabolically unhealthy individual can mean different things. Next, he discusses how Zone 2 training boosts mitochondrial function and impacts longevity. He explains the different metrics for assessing one’s Zone 2 threshold and describes the optimal dose, frequency, duration, and type of exercise for Zone 2. Additionally, he offers his thoughts on how to incorporate high intensity training (Zone 5) to optimize health, as well as the potential of metformin and NAD to boost mitochondrial health. Finally, he discusses insights he’s gathered from studying the mitochondria of long COVID patients in the ICU. We discuss: The amazing potential of cyclist Tadej Pogačar [2:00]; Metrics for assessing athletic performance in cyclists and how that impacts race strategy [7:30]; The impact of performance-enhancing drugs and the potential for transparency into athletes’ data during competition [16:15]; Tadej Pogačar’s race strategy and mindset at the Tour de France [23:15]; Defining Zone 2, fat oxidation, and how they are measured [26:00]; Using fat and carbohydrate utilization to calculate the mitochondrial function and metabolic flexibility [35:00]; Lactate levels and fat oxidation as it relates to Zone 2 exercise [39:15]; How moderately active individuals should train to improve metabolic function and maximize mitochondrial performance [51:00]; Bioenergetics of the cell and what is different in elite athletes [56:30]; How the level of carbohydrate in the diet and ketogenic diets affects fuel utilization and power output during exercise [1:07:45]; Glutamine as a source for making glycogen—insights from studying the altered metabolism of ICU patients [1:14:15]; How exercise mobilizes glucose transporters—an important factor in diabetic patients [1:20:15]; Metrics for finding Zone 2 threshold—lactate, heart rate, and more [1:24:00]; Optimal Zone 2 training: dose, frequency, duration, and type of exercise [1:40:30]; How to incorporate high intensity training (Zone 5) to increase VO2 max and optimize fitness [1:50:30]; Compounding benefits of Zone 2 exercise and how we can improve metabolic health into old age [2:01:00]; The effects of metformin, NAD, and supplements on mitochondrial function [2:04:30]; The role of lactate and exercise in cancer [2:12:45]; How assessing metabolic parameters in long COVID patients provides insights into this disease [2:18:30]; The advantages of using cellular surrogates of metabolism instead of VO2 max for prescribing exercise [2:25:00]; Metabolomics reveals how cellular metabolism is altered in sedentary individuals [2:33:00]; Cellular changes in the metabolism of people with diabetes and metabolic syndrome [2:38:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter delves into two topics that have generated a lot of questions over the years: skin cancer and sunscreen. He begins by exploring the basics of UV radiation, discussing its effects on vitamin D conversion, photoaging, and its role in skin cancer. He examines various skin types, discussing their implications for sun exposure and vitamin D levels, as well as how to determine where you fall on the skin type scale. He then delves into the various types of skin cancer, with a particular emphasis on melanoma, exploring its complex relationship with UV exposure and other contributing risk factors. Additionally, he covers tanning beds, the importance of early skin cancer detection through regular skin checks, and the often confusing topic of sunscreen. He explains how sunscreen affects UV radiation and skin cancer risk, what SPF levels to choose, the differences between organic and mineral sunscreens, and what to consider when selecting the best sunscreen for your needs. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #61 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: The impact of UV radiation on the skin [2:00]; Understanding solar UV: from the electromagnetic spectrum to skin health [3:45]; The role of sunlight in vitamin D production [8:30]; Factors contributing to vitamin D deficiency: insufficient UV exposure, magnesium levels, and more [9:45]; Sun exposure needs for different skin types, and the limitations of current studies in defining vitamin D deficiency [12:45]; The acute and long-term effects of excessive UV exposure: sunburn, photoaging, and the increased risk of skin cancer [15:30]; Types of skin cancer and associations with UV exposure [17:45]; The complex relationship between melanoma and UV exposure [22:15]; Why UV exposure alone doesn’t necessarily explain the risk for melanoma [25:15]; Other risk factors for melanoma [29:15]; Tanning beds and skin cancer risk [34:45]; Balancing sun exposure: benefits and risks [38:15]; Tattoos and sun exposure [40:30]; The importance of regular skin checks, dermatologists, and emerging technologies showing promise for early detection of cancer [41:45]; Self-skin checks: what to look for [46:30]; Prevalence of skin cancer and the importance of early detection [49:30]; Summary of the major risk factors for melanoma [54:15]; The role of sunscreen in reducing skin cancer risk [55:45]; How sunscreen works, the differences between chemical and mineral sunscreens, an explanation of SPF, and more [58:30]; How to determine the appropriate sunscreen SPF to use based on the UV index [1:04:45]; Choosing the right sunscreen for your individual needs [1:07:00]; The impact of water and perspiration on sunscreen effectiveness [1:12:00]; Chemical vs. mineral sunscreens: safety concerns and recommendations [1:14:00]; Concerns about hormone effects from chemical sunscreens [1:19:15]; Sunscreen summary: skin types, key considerations, recommended brands, and more [1:23:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this special episode, Peter addresses the common questions about starting or returning to an exercise routine over the age of 50. Individuals in this age group have frequently reached out with questions about whether it's too late to start exercising and often express concern over a lack of prior training, a fear of injury, or uncertainty about where to begin. Peter delves into the importance of fitness for older adults, examining all four pillars of exercise, and provides practical advice on how to start exercising safely, minimize injury risk, and maximize potential benefits. Although this conversation focuses on people in the “older” age category, it also applies to anyone of any age who is deconditioned and looking to ease into regular exercise. We discuss: Key points about starting exercise as an older adult [2:45]; Why it’s never too late to begin exercising and incorporating the four pillars of exercise [5:45]; The gradual, then sharp, decline in muscle mass and activity level that occur with age [10:00]; The decline of VO2 max that occurs with age [15:30]; Starting a training program: exercise variability, movement quality, realistic goals, and more [18:30]; Improving aerobic capacity: the malleability of the system, the importance of consistency, and setting long-term fitness goals [25:15]; Starting cardio training: base building, starting with low volume, and zone 2 training [30:45]; The critical role of VO2 max in longevity [36:45]; How to introduce VO2 max training to older or deconditioned individuals [46:15]; Options for performing zone 2 and VO2 max training [53:45]; The ability to make gains in strength and muscle mass as we age [57:00]; How to implement strength training for older individuals [1:01:00]; Advice for avoiding injury when strength training [1:07:30]; Risk of falls: the devastating consequences and the factors that increase fall risk [1:12:15]; Mitigating fall risk: the importance of foot and lower leg strength, ankle mobility, and balance [1:19:45]; Improving bone mineral density through resistance training [1:24:30]; The importance of protein in stimulating muscle protein synthesis, especially in older adults [1:31:00]; Parting advice from Peter [1:34:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter provides insights on a broad range of important topics. He delves into the prevention of cognitive decline, the link between cardiovascular disease and Alzheimer's disease, and methods to lower blood glucose, insulin, and apoB. He also addresses nutrition-related queries, exploring the impact of dietary habits on weight loss and longevity, how a person can identify the best diet for themselves, and common nutrition myths. Additional discussions include optimal blood pressure, daily step goals, the benefits of standing versus sitting desks, and much more. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #60 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Overview of topics and episode format [1:40]; Preventing cognitive decline [5:00]; How to lower blood glucose and insulin [13:30]; The relationship between lipids, CVD, and Alzheimer’s disease, and whether statins can increase the risk of neurodegenerative disorders and AD [23:15]; Reducing apoB levels through exercise and diet [31:45]; Pharmacological options for lowering apoB [38:00]; How nutrition impacts longevity via metabolic health, muscle mass, BMD and more [40:15]; How can someone determine the best diet for themselves? [43:45]; Nutrition myth: All weight loss is good [46:45]; Nutrition myth: Metabolic rates are dramatically different among individuals based on genetics [49:00]; Nutrition myth: Losing weight after a brief period of overeating is impossible [53:45]; Nutrition myth: GLP-1 agonists are a replacement for a healthy lifestyle [57:45]; Nutrition myth: There is a single best diet for weight loss [1:03:00]; Nutrition oversimplification: All calories are created equal [1:05:45]; Daily step goals [1:06:45]; The benefits of standing versus sitting throughout the day [1:10:45]; How to identify the most impactful and easiest-to-implement ways to improve your health [1:12:30]; The critical importance of emotional health [1:14:30]; Why supplements should be considered as supportive aids rather than primary solutions in one’s strategy to improve longevity [1:18:00]; Strategies for reducing high blood pressure [1:20:45]; Peter’s biggest frustrations with "mainstream health advice" [1:28:00]; Peter’s chaotic, yet cherished, morning routine [1:31:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Joel Jamieson is a conditioning expert who developed Morpheus to give people a smarter way to build their conditioning regimen and improve their recovery. In this episode, Joel dives deep into the world of heart rate variability (HRV), explaining its scientific foundation, how it measures the balance between the sympathetic and parasympathetic nervous systems, the various methods of measurement, and how it can guide healthier lifestyle choices and improved training performance. He explores the nuances of HRV calculation, the impact of aging on HRV, and the roles of genetics, exercise, and other lifestyle factors in this process. He also covers Morpheus, the innovative training tool that won Peter over after his initial skepticism, highlighting its practicality and effectiveness in guiding training and optimizing fitness outcomes. We discuss: Heart rate variability (HRV): evolution, science, and practical applications of HRV in athletic training [4:00]; Methods of measuring HRV: EKG, wrist-based sensors, and more [11:30]; How HRV is calculated from the data [22:30]; The role of the autonomic nervous system (ANS) in regulating HRV [25:45]; The decline in HRV with age, and the mitigating effects of fitness and other lifestyle factors [33:30]; The role of genetics in HRV, the modifiability of HRV, and a comparison of VO2 max and HRV as predictors of mortality [37:00]; How aging affects HRV and sympathetic drive, and the importance of spontaneous movement and exercise in maintaining the body's adaptability [43:30]; How Morpheus measures HRV using RMSSD and normalizes it to a 100-point scale for easier interpretation [49:45]; The Morpheus system: development, integration with various metrics, and personalized daily training recommendations to optimize fitness and recovery [51:30]; The benefits of morning HRV readings for assessing daily readiness compared to overnight HRV measurements [1:03:00]; Why Morpheus recommends using a chest strap rather than an arm band [1:10:00]; The impact of consistent exercise, stress, alcohol, and other lifestyle factors on HRV [1:11:15]; Optimizing zone 2 training with Morpheus [1:18:15]; Using heart rate recovery (HRR) as an indicator of athletic conditioning and the balance between aerobic and anaerobic systems [1:22:45]; The importance of tracking HRV trends over time rather than focusing on data from a given day [1:29:00]; Effect of GLP-1 agonists on heart rate and HRV [1:34:45]; Where HRV belongs in the hierarchy of health metrics [1:42:00]; Parting thoughts [1:46:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this quarterly podcast summary (QPS) episode, Peter introduces a new format aimed at summarizing his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from each episode, covering diverse topics such as protein and muscle building with Luc van Loon, toe strength with Courtney Conley, VO2 max with Olav Aleksander Bu, liquid biopsies for cancer with Alex Aravanis, gut health and probiotics with Colleen Cutcliffe, and road safety with Mark Rosekind. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these engaging discussions. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the episode #304 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: How Peter keeps track of his takeaways from each podcast episode [5:15]; Luc van Loon episode: fat utilization, muscle protein synthesis, dietary protein, aging and inactivity, and more [8:45]; Behavioral changes that have come about from the conversation with Luc van Loon [23:45]; Courtney Conley episode: importance of toe strength and the impact of dedicated foot training [26:45]; Olav Aleksander Bu episode: the importance of VO2 max for lifespan, and the practicalities of measuring and improving VO2 max [36:45]; Behavioral changes that have come about from the conversation with Olav [56:00]; Alex Aravanis episode: liquid biopsies for cancer detection [1:01:30]; Colleen Cutcliffe episode: the importance of gut bacteria balance, and the potential therapeutic uses of probiotics, particularly Akkermansia [1:16:45]; Mark Rosekind: the significant issue of road fatalities and injuries, their causes, and practical safety measures to reduce risks [1:27:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Dena Dubal is a physician-scientist and professor of neurology at UCSF whose work focuses on mechanisms of longevity and brain resilience. In this episode, Dena delves into the intricacies of the longevity factor klotho: its formation and distribution in the body, the factors such as stress and exercise that impact its levels, and its profound impact on cognitive function and overall brain health. Dena shares insights from exciting research in animal models showing the potential of klotho in treating neurodegenerative diseases as well as its broader implications for organ health and disease prevention. She concludes with an optimistic outlook for future research in humans and the potential of klotho for the prevention and treatment of Alzheimer’s disease. Disclosure: Peter is an investor in Jocasta Neuroscience, a company working to develop klotho as a therapy for people with Alzheimer’s disease. We discuss: Dena’s fascination with aging and how she came to study klotho [3:30]; Biological properties of klotho: production, regulation, decline with age, and factors influencing its levels [11:45]; Potential benefits of klotho on brain health [22:00]; The relationship between soluble klotho protein, platelet factors, and cognitive enhancement [33:45]; The role of platelet factor 4 (PF4) and it’s interaction with GluN2B in mediating cognitive enhancement [46:45]; Benefits of klotho observed in a mouse model of Parkinson’s disease [55:45]; Benefits of klotho observed in a mouse model of Alzheimer’s disease [1:03:00]; Promising results of klotho in primate models, and the importance of finding an appropriate therapeutic dose before moving to human trials [1:08:00]; Speculating why a single klotho injection has such long-lasting effects [1:25:30]; Potential cognitive benefits of klotho in humans, the impact of the KL-VS genetic variant on klotho levels, and the need for human trials to confirm these effects [1:27:45]; The interaction between the KL-VS genetic variant and APOE4 and how it impacts risk of Alzheimer’s disease [1:34:45]; The significance of klotho levels: studies linking lower levels to increased mortality and the broader implications for organ health and disease prevention [1:47:15]; Measuring klotho levels and determining an individual’s KL-VS status [1:52:15]; The promising potential of klotho for Alzheimer’s disease treatment, and the importance of philanthropy for funding research [1:58:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Julia Wattacheril is a physician scientist and director of the Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) program at Columbia University Irving Medical Center. In this episode, Julia delves deep into the complex world of liver health, beginning with a foundational overview of liver physiology. She provides an in-depth look at how alcohol impacts liver function, breaking down the metabolism of ethanol and its detrimental effects. Julia then shifts the focus to understanding liver function tests and optimal enzyme levels, providing a detailed explanation of AST and ALT and elucidating why fluctuations in these levels may or may not be concerning. She provides a primer on the four major stages of liver disease, discussing risk and emphasizing the importance of early diagnosis. Julia highlights the role of liver disease in increasing the risk of cancer and cardiovascular disease and covers in detail the various strategies for diagnosing, treating, and preventing the progression of liver disease. We discuss: Julia’s training, the importance of liver health, and the challenges and innovations of hepatology [3:15]; The complex and crucial functionality of the liver, its four most essential functions, and more [8:45]; Liver injuries: historical and evolving understanding of causal factors, and the progression to liver diseases and cancer [13:15]; How the liver metabolizes nutrients and what happens in the presence of excess calories or alcohol [24:45]; Methods of diagnosing liver disease and how insights guide treatment and management strategies [33:30]; The poisonous nature of ethanol to the liver [40:30]; Varied responses to alcohol, damaging effects of alcohol beyond the liver, and the process of advising patients on their alcohol consumption [47:15]; Understanding liver enzymes AST and ALT—interpreting levels, lifestyle factors that affect them, and diagnostic approaches [58:30]; Interpreting liver function tests for fatty liver disease, and the challenges of diagnosing liver pathologies, particularly in children versus adults [1:13:15]; Comprehensive liver health assessments via imaging and various diagnostic tools to prevent overlooking potential liver pathologies [1:18:45]; Potential impact of recreational drugs, statins, and other medications on liver function test results [1:26:45]; Shifting nomenclature from NAFLD to MASLD to reflect accuracy in the underlying pathophysiology and understanding of liver diseases [1:30:30]; Pathophysiology of MASLD, the need for proactive screening, and the significance of liver fat percentage as an indicator of metabolic health [1:36:30]; The importance of screening for rare conditions alongside common metabolic diseases associated with fatty liver accumulation [1:42:45]; Practical strategies for managing MAFLD [1:45:30]; The impact of fructose consumption on liver health and the challenges of disentangling its effects from other factors like obesity and insulin resistance [1:52:45]; The potential of GLP-1 agonists for the treatment of MASLD [1:57:45]; How the four stages of liver disease have evolved [2:00:30]; Increased cancer and heart disease risk associated with early-stage MAFLD [2:05:15]; Emerging drugs and therapies for addressing fat accumulation and fibrosis related to MAFLD [2:12:15]; Peter’s major takeaways [2:18:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter delves into the often misunderstood concept of inflammation. He first defines inflammation and differentiates between acute inflammation and chronic inflammation, the latter of which is linked to aging and a plethora of age-related diseases. Peter breaks down the intricate relationship between chronic inflammation, obesity, and metabolic health, and highlights the signs that might suggest someone may be suffering from chronic inflammation. From there, the conversation centers on actionable advice and practical steps one can take to manage and minimize chronic inflammation. He explores how diet plays a crucial role, including the potential benefits of elimination diets, and he examines the impact of lifestyle factors such as exercise, sleep, and stress management. Additionally, he discusses the relevance of food inflammatory tests and concludes by examining the potential benefits and drawbacks of drugs and supplements in managing inflammation. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #59 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Defining inflammation (and the cultural impact of Napoleon Dynamite) [1:45]; Acute vs chronic inflammation [8:00]; The connection between chronic inflammation, aging, and age-related diseases [11:00]; The impact of inflammation on metabolic health [18:30]; Understanding and diagnosing chronic inflammation: blood tests and other approaches, and challenges with measurement [20:00]; Factors that contribute to low-level chronic inflammation [28:00]; Minimizing inflammation through diet [29:45]; The important role of fiber for gut health and inflammation [33:45]; A closer look at the impact of trans fats and saturated fats on overall health [34:45]; Why Peter prefers dietary fiber from food sources over supplements [38:30]; Debunking “superfoods”: emphasizing proven methods over marketing claims for reducing inflammation [39:00]; Is there any value in over-the-counter food inflammatory tests? [42:30]; Food elimination diets: how they work, symptoms and markers to watch, challenges and limitations [45:15]; Identifying dietary triggers for gut-related symptoms through low-FODMAP diets like the “carnivore diet” [51:15]; Dairy: the complex role of dairy on inflammation and individual responses [55:00]; Wheat: the complexities and conflicting evidence around wheat's inflammatory effects [57:45]; How exercise influences inflammation [1:02:00]; How sleep quality and duration impacts inflammation [1:07:00]; The potential impact of chronic psychological stressors on inflammation [1:13:00]; The impact of oral health on inflammation and overall well-being [1:15:00]; The role of medications in managing chronic inflammation [1:18:15]; Supplements: evaluating the efficacy of various anti-inflammatory supplements [1:22:15]; Parting thoughts and takeaways [1:27:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this special edition celebrating 300 episodes of The Drive, Peter discusses a variety of popular topics and health interventions and classifies them based on their level of evidence and relevance using the following categories: proven, promising, fuzzy, noise, and nonsense. Peter first delves into the topic of geroprotective molecules, covering rapamycin, metformin, NAD and its precursors, and resveratrol. Next, he explores the significance of metrics like VO2 max and muscle mass, as well as emerging concepts like blood flow restriction and stem cells. The conversation extends to nutrition, addressing questions surrounding long-term fasting, sugar consumption, sugar substitutes, and the contentious role of red meat in cancer. Peter not only provides his current stance on each topic—most of which have been covered in great detail in the previous 300 episodes—but also reflects on how his opinion may have evolved over the years. We discuss: Defining the categories of “proven, promising, fuzzy, noise, and nonsense” [3:15]; Rapamycin [9:30]; Metformin [17:00]; NAD and its precursors [24:30]; Resveratrol [32:45]; The importance of VO2 max, muscle mass, and muscular strength for lifespan [38:15]; Blood flow restriction (BFR) training [44:00]; Using stem cells to treat osteoarthritis or injury [51:30]; Fasting as a tool for longevity (and why Peter stopped his fasting protocol) [55:45]; The energy balance theory [1:06:30]; The idea that sugar is poison [1:12:00]; The idea that sugar substitutes are dangerous [1:22:15]; The debate on red meat and cancer [1:28:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter This is a special episode of The Drive with Peter’s friend and fellow car enthusiast Dax Shepard. In this podcast, which commemorates the 30th anniversary of the death of Brazilian Formula One legend Ayrton Senna, Dax sits down with Peter to better understand what made Senna so special and why Peter remains an enormous fan. This conversation focuses on Senna’s life, the circumstances of his death, and his lasting impact and legacy on the sport of F1. We discuss: Peter’s interest in motorsports began as a child [2:30]; The drama and dangers of F1 [6:00]; What made Senna special [13:00]; What Senna meant to Brazilians [24:00]; The cause of the fatal crash [28:15]; Why Peter is obsessed with Senna [40:30]; Being the best versus having the best record [43:30]; Senna’s unique driving style and incredible intuition about automotive engineering [46:30]; Back to the day of the dreadful race [53:00]; What Peter believes caused the crash [1:02:45]; Views on dying young, in the prime of life [1:13:00]; Senna lives on in his foundation and in safety changes adopted by F1 [1:21:00]; Statistics aren’t enough for fandom, and why people like who they do [1:24:15]; The biggest difference between F1 today and F1 in the 80s [1:28:30]; Senna’s driving superpower [1:30:30]; The fastest drivers currently in F1 [1:38:30]; Current F1 obsessions [1:45:00]; How hard it is to do what the top F1 drivers do [1:50:15]; Dax’s love of motorcycles and his AMG E63 station wagon [1:52:15]; Awesome Senna mementos from Etsy [2:01:15]; What makes specialists interesting, and Max’s devotion to F1 [2:10:15]; What Senna might have done if he had not died that day [2:14:00]; Michael Schumacher and Max Verstappen are also top F1 drivers [2:17:30]; Interlagos in Sao Paulo Brazil is always an incredible experience [2:18:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Luc van Loon is an internationally renowned expert in skeletal muscle metabolism. In this episode, Luc starts with an exploration of the roles of insulin and triglycerides in endurance exercise, highlighting their impact on skeletal muscle metabolism, and he offers profound insights into the significance of protein in this context. He elucidates how different protein types and forms influence muscle protein synthesis rates, exploring the nuances of protein absorption, digestibility, amino acid quality, and their implications for performance and recovery. Delving deeper, he differentiates between animal and plant protein sources, unraveling the distinctive properties of various protein types, from the differences between whey and casein to the emerging trends in collagen protein supplementation. Moreover, Luc dissects the intricate connections among physical activity, lean muscle mass, muscle protein synthesis induced by resistance training, and dietary protein. We discuss: Luc’s background and insights about fuel selection during exercise [3:30]; Fuel utilization during endurance exercise [9:30]; Fat metabolism, intramuscular lipids, and the nutritional dynamics of endurance sports [17:15]; The optimal window for replenishing intramuscular fat stores and glycogen post-exercise [25:15]; Luc’s interest in protein metabolism and exploration of amino acids' dual role as building blocks and signaling molecules in driving muscle protein synthesis [32:15]; How protein metabolism differs between sedentary individuals and those engaged in predominantly strength training or endurance training [38:45]; The basics of how proteins are digested and absorbed, and how muscle protein synthesis is measured [50:30]; How factors like food texture, cooking methods, and protein composition impact muscle protein synthesis, and the importance of protein distribution throughout the day [59:45]; Differences in whey and casein proteins, and the ability of ingested protein to stimulate muscle protein synthesis [1:03:30]; Dietary protein distribution and quantity for the maximization of muscle protein synthesis [1:09:00]; Muscle loss with age and inactivity and the importance of resistance exercise to maintain type II muscle fibers [1:17:15]; Differences between whey and casein proteins, and the importance of both quantity and quality of protein sources [1:28:30]; Optimizing muscle protein synthesis: exercise, timing of protein intake, protein quality, and more [1:37:00]; How to preserve muscle while trying to lose weight [1:46:00]; Anabolic resistance and overcoming it with physical activity [1:55:45]; Importance of protein intake and physical activity in hospitalized patients [2:06:30]; Reviewing the efficacy of collagen supplements [2:13:30]; Plant-based diets: how to ensure a balance of amino acids, and other considerations [2:20:30]; Future research: understanding protein metabolism in the brain [2:23:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Paul Conti is an author and practicing psychiatrist who specializes in helping people heal from trauma. In this episode, Paul returns to The Drive to delve into the intricate relationship between emotional health, healthspan, and lifespan. He first challenges common assumptions about the inevitable decline of emotional health with age, providing strategies for conducting a comprehensive audit of internal emotional health. He establishes a framework for the foundation of good emotional health: a balance between the generative drive, the assertive drive, and the pleasure drive. Paul also explores the nuanced dynamics of motivation, happiness, and satisfaction as it relates to material possessions, draws connections between physical and emotional well-being, confronts the impact of negative self-talk, and describes how making peace with our mortality can foster a sense of hope, purpose and well-being. Additionally, Paul offers many practical insights into initiating emotional health improvements and navigating the search for a suitable therapist. We discuss: The importance of prioritizing emotional health as we age [2:45]; The impact of emotional health on healthspan and how to foster a proactive approach to emotional well-being [7:00]; The discrepancy between outward success and inner fulfillment, and the importance of a healthy “generative drive” for genuine well-being [13:00]; A deeper dive into generative drive: impact on human behavior, resilience, purpose, and more [23:15]; Evaluating one’s inner self: introspection, self-awareness, challenging societal norms, and returning to the basics of physical and emotional well-being [29:00]; Self-auditing tools: introspection, curiosity, and exploring underlying reasons for unwanted behaviors [41:45]; Breaking free from destructive cycles by understanding the continuum of self-care and addictive behaviors and remaining curious [50:15]; Critical self talk: the malleability of one’s inner dialogue and the potential for transformative change with perseverance and self-compassion [1:00:15]; Slowing the anger response and gaining insights into the underlying triggers to achieve lasting change and self-understanding [1:13:45]; Foster gratitude and humility by achieving balance between the three drives—assertion, pleasure, and generative [1:20:45]; The conflict between intellectual understanding and emotional feelings, problematic comparison frameworks, and the importance of living in the present with intentionality [1:24:15]; How making peace with our mortality can foster a sense of hope, purpose and well-being [1:34:45]; Advice for finding a compatible therapist [1:43:45]; The key components of therapeutic progress [1:57:00]; The caricatures of four common patient phenotypes, and how to get through to them [2:05:30]; How Paul manages his own well-being and the emotional challenges that come with his line of work [2:15:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter delves into the crucial yet often overlooked topic of iron and iron deficiency. He explores why iron is indispensable for the body, explains the repercussions of iron deficiency, and sheds light on the prevalence of this issue and who is most susceptible. Peter outlines strategies for increasing iron levels, covering dietary iron, supplementation, and infusion options, while also discussing the suitability of each approach for different individuals. Shifting gears, Peter tackles rapid-fire questions on creatine and sodium, as well as inquiries related to his book. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #58 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Overview of today’s topics and the importance of understanding iron levels in the body [1:45]; The importance and ubiquity of iron in the body, and the role of the protein called ferritin [4:30]; The processes of iron absorption, utilization, and transportation [9:30]; Options for testing iron levels and how to interpret the results [13:45]; What does it mean to be iron deficient, and how is it different from anemia? [17:15]; Symptoms of iron deficiency and/or anemia [22:15]; How prevalent is iron deficiency, and who is most susceptible? [24:30]; The importance of consuming an adequate amount of iron daily to prevent deficiency [30:30]; The best way to improve iron levels for someone who is deficient [34:45]; Iron supplementation: various formulations and potential side effects [37:45]; Intravenous iron infusion as an alternative to oral supplements -- plus restless legs syndrome and other topics [42:00]; Iron supplementation: who should and should not consider it [44:00]; Peter’s approach to creatine and his pre- and post-workout supplements [50:15]; Navigating sodium intake: effect on blood pressure, who should use precaution, and other considerations [54:45]; Peter’s thoughts about the potential of writing another book [57:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Courtney Conley is an internationally renowned foot and gait specialist. In this episode, Courtney delves into the intricate world of foot anatomy and functionality. She explores the complexities of the foot, discussing its anatomy, common injuries, and the importance of understanding its structure in preventing issues. She covers a range of foot ailments, factors contributing to them, treatment options, and prevention strategies. She delves into the significance of loading, balance, range of motion, and posture, emphasizing the crucial role of strength in preventing both injuries and falls. Additionally, she sheds light on the interconnectedness of the kinetic chain, from the leg muscles down to the foot, and how issues within this chain can cascade downstream, leading to various injuries and pathologies. Additionally, she provides a comprehensive overview of footwear, discussing suitable options for both adults and children to promote foot health and mitigate potential problems. In addition to this interview, Courtney also recorded a series of videos to better explain a number of the concepts discussed such as diagnostic tests that are used to determine mobility and strength and the exercises one should perform to improve the outcomes based on the diagnostics. The interview will be available to everyone while the videos from the gym will only be available to paid subscribers (found at the end of the show notes page). We discuss: Why Courtney chose to specialize in the foot [3:30]; The vital role of foot strength, function, and health in human movement and well-being [6:15]; Anatomy of the rear foot and midfoot [10:15]; The development of flat feet, the impact of footwear, and the benefits of going barefoot [19:45]; Anatomy of the forefoot, common injuries, and why most injuries occur in the forefoot [23:15]; Foot musculature and its role in maintaining foot stability and preventing deformities like bunions and hammer toes [30:15]; The intrinsic musculature of the foot, plantar fasciitis, footwear, and more [39:00]; Plantar fasciitis: diagnosis, causes, and treatment [51:30]; Posterior leg muscles: strength assessment methods, role in ACL injuries, and more [59:15]; Lateral and medial muscles: ankle stability, arch support, big toe stabilization, and exercises to strengthen and prevent injuries [1:04:15]; Importance of strength of lower leg muscles for gait and preventing shin splints, stress injuries, and more [1:08:15]; Tendinopathies and other common pathologies related to the anterior and lateral compartments of the foot [1:13:00]; The importance of midfoot integrity, ankle dorsiflexion, and a discussion of gait alterations [1:19:45]; Proximal stability and its implications for posture and movement patterns [1:27:00]; The age-related decline in foot sensation and strength [1:32:45]; Common toe injuries, treatment, and how to prevent further progression of the injury [1:36:30]; Preventing falls and managing arthritis with proactive foot care and exercises [1:46:45]; Footwear: advice for picking shoes that promote foot health [1:54:45]; Footwear for runners [2:05:30]; The importance of prioritizing footwear that promotes natural foot movement and strength while considering individual comfort and foot health needs [2:09:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Mark Rosekind is an expert on road safety and a policy leader with more than 30 years of experience enacting strategic, practical, and effective data-based solutions that enhance driver and pedestrian safety and health in complex environments. In this episode, Mark delves into the persistent issue of accidental deaths resulting from roadway accidents, a concern for those focused on longevity given its consistent risk throughout life. From exploring statistics on car crashes to identifying the demographics most at risk and the key locations of incidents, he uncovers various risk factors including distractions like smartphone usage, the influence of alcohol and cannabis, the dangers of sleep deprivation, and speeding. Mark also provides practical advice for both drivers and pedestrians to enhance safety, while delving into the potential and challenges of emerging technologies such as autonomous vehicles. Additionally, Mark provides valuable resources for listeners, particularly parents navigating the road safety landscape with teenage drivers. We discuss: Mark’s background and education, and the profound impact of transportation accidents on human lives [4:15]; From sleep science to safety leadership: Mark’s journey in transportation innovation [14:15]; Stats on transportation accidents and fatalities [18:00]; Historical trends in road fatalities and the key contributors—impairment, distraction, and more [28:00]; The demographics of drivers involved in crashes, and the life-saving potential of better driver education programs [34:30]; The most critical areas where drivers need to be hyper-aware to protect themselves [41:00]; The role of the National Transportation Safety Board (NTSB) in accident investigations, and the importance of data sources like event data recorders (EDRs) in accident reconstruction and investigations [47:00]; The dangers of phone use while driving [53:45]; How drunk driving was addressed through advocacy and legal changes [1:01:30]; The need to address distracted driving and the psychological impact of distracted driving accidents on both victims and perpetrators[1:07:15]; Navigating the roads and lowering your risk of accidents: weather, human error, and defensive driving [1:15:45]; The impact of impaired driving: alcohol, cannabis, prescription drugs, and more [1:26:15]; Mitigating the effects of vehicle speed [1:38:15]; The promise and challenges of autonomous vehicles for road safety [1:44:15]; Automatic emergency braking (AEB): the effectiveness and challenges of implementing AEB as a standard feature in new vehicles [1:53:00]; Sleep deprivation: the impact of poor sleep, drowsiness, and disrupted circadian rhythm on driving [1:58:15]; Protecting pedestrians: strategies for reducing the risk of fatal accidents with pedestrians on foot or bicycle [2:02:30]; Empowering safe driving: essential resources and tips for parents and teenage drivers [2:14:00]; Promoting a culture of proactive safety: parting thoughts from Mark [2:19:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Olav Aleksander Bu is an internationally renowned sports scientist acclaimed for his coaching prowess with elite athletes spanning a diverse range of sports disciplines. In this episode, Olav delves deep into the intricacies of VO2 max and its profound impact on performance. They explore the relationship between VO2 max and ATP production, energy efficiency, and power, as well as the impact of low-intensity training on VO2 max. The conversation extends to Olav’s experiences pushing the boundaries with high-performance athletes and the data driven interventions he uses to improve performance. They also dissect the role of lactate threshold, discuss other important metrics to track, and explore the exciting possibility of utilizing a portable VO2 testing device as a practical alternative to traditional lab-based assessments. We discuss: Olav’s background, expertise in exercise physiology, coaching experience, and interest in the extremes of human capability [4:15]; The processes of energy conversion within the human body and its implications for performance [9:30]; Improving movement efficiency, and the importance of mindfulness in training to optimize performance [20:00]; The relationship between VO2 max, power output, and endurance performance in different sporting contexts [34:45]; How VO2 max is measured in the lab, and why it’s a crucial predictor of both lifespan and quality of life [44:45]; Absolute vs relative VO2 max, the significance of functional threshold power in cycling, and the importance of longer duration tests for accurate assessments [54:00]; Portable VO2 testing devices as a practical alternative to lab-based tests [1:05:15]; The complexities of measuring ventilation and its impact on performance metrics like VO2 max and heart rate [1:15:45]; Training interventions to increase VO2 max, and factors that impact performance outcomes [1:23:30]; The respiratory exchange ratio (RER) and endurance sports, and how factors such as diet composition and exercise intensity influence RER values and performance [1:32:45]; Science-guided training for versatile athletes: maximizing VO2 max, power, torque, and cadence in cycling, and the importance of incorporating diverse stimuli to enhance performance [1:41:00]; Physiological limitations on VO2 max [2:02:15]; The different energy systems used during work, and other things to monitor like VCO2 and heart rate [2:06:00]; Lactate threshold and other metrics to guide your training [2:10:30]; Analysis of a lactate power curve: exploring lactate dynamics in endurance training and performance [2:23:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube  

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter delves into the topic of high-intensity interval training (HIIT), starting with addressing some common misunderstandings around this type of exercise and breaking down what HIIT truly entails. He examines the correlation between HIIT and VO2 max, a vital metric for overall health and longevity, and describes the beneficial impact of HIIT on longevity when incorporated properly. Additionally, he emphasizes the importance of building a wide base of cardiovascular fitness, reveals the optimal protocols for incorporating HIIT into a balanced routine, and discusses the risk of injury and other potential drawbacks of HIIT. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #57 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Common questions about high-intensity interval training (HIIT) [1:30]; The origins of HIIT [3:15]; Defining HIIT training and differentiating it from sprint interval training (SIT) [5:45]; Why HIIT is often touted as a more efficient way to exercise [14:00]; Navigating the nuances of HIIT research: understanding limitations and the importance of a blended exercise routine [20:30]; The four pillars of exercise [24:15]; Using HIIT to improve VO2 max [26:00]; HIIT training for the untrained individual: impact on VO2 max and the interplay between exercise-induced adaptations and potential weight loss [33:00]; Sprint interval training (SIT) vs. HIIT: comparing the relative improvements in VO2 max and the impact of longer duration intervals [40:00]; Benefits and limitations of HIIT, drawbacks of overtraining with HIIT, and the importance of a diversified routine to increase total cardiorespiratory capacity [44:15]; HIIT protocols Peter recommends [58:45]; The risk of injury and other potential drawbacks of HIIT [1:02:15]; The importance of incorporating a balance of continuous moderate-intensity cardio and HIIT when aiming for longevity [1:04:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube  

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Jason McCarthy is a former US Special Forces member and the founder of GORUCK, a company specializing in rucking equipment. In this episode, Jason recounts his journey from military service to navigating the challenging transition back into civilian life and ultimately embracing the mission of introducing rucking to the masses. Delving into the significance of rucking in military training and its applicability to the wider population, he discusses the mental and physical benefits of rucking as a mode of training, provides practical tips for beginners, and answers frequently asked questions about packs, weights, footwear, and more. We discuss: Jason’s upbringing and what inspired him to join the military [3:15]; Jason’s path to becoming a Green Beret, his calling to serve, and staying true to oneself [10:30]; About the Green Berets: their role in the military, unique abilities, missions, and more [20:00]; The mental and physical challenges of special forces training and selection [25:00]; Rucking challenges as a Green Beret [37:00]; How Jason trained in his off-time and stayed mentally prepared [46:30]; Jason’s difficult decision to leave the army, and the challenges many veterans face returning to civilian life [51:30]; Jason’s struggles after leaving the army: loss of identity, feelings of shame, and the how he overcame a period of despair [57:15]; The origin of GORUCK [1:10:30]; The GORUCK Challenge [1:24:30]; The company's evolution from event organizer to manufacturing specialist, spurred by the growing interest in rucking as a form of training [1:35:30]; FAQs about rucking: packs, weight, rucksack vs. weighted vest, chest straps, and more [1:38:45]; Commemorating Normandy: GORUCK's plans for the 80th anniversary of the Normandy landings [1:51:30]; Footwear for rucking, and how GORUCK got into the footwear business [1:57:30]; How to avoid the most common injuries from rucking, and the benefits of rucking for VO2 max, strength, and sleep quality [2:05:00]; Advice for using rucking as a mode of training, and the advantages of rucking over other forms of training [2:12:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Derek is a fitness educator, the entrepreneur behind More Plates More Dates, and an expert in exogenous molecules commonly used and misused by bodybuilders and athletes. In this episode, Derek returns to the podcast to explore the impact of exogenous molecules on male and female health. He covers testosterone, DHT, DHEA, progesterone, clomiphene (Clomid), hCG, and various peptides, alongside updates from the FDA affecting peptide use. Additionally, he addresses the recent hype around increasing muscle mass through myostatin inhibition via follistatin gene therapy and supplementation. Additionally, Derek discusses the various strategies that bodybuilders use for losing fat while preserving muscle, including insights on weight loss drugs. We discuss: Testosterone and DHT: mechanisms of action, regulation of muscle growth, and influence on male and female characteristics [2:15]; TRT in women: the complexities and potential risks associated with testosterone use in women [9:00]; DHEA supplementation: exploring the benefits and risks for women, and the differing effects on men vs. women [22:00]; The role of progesterone in both men and women, pros and cons of supplementation, the importance of tailored doses, and more [28:00]; Measuring levels of free testosterone [37:15]; The trend towards earlier interest in TRT, and the risks of underground sources of testosterone [42:00]; The complexities and considerations surrounding the use of Clomid, E-Clomid, and hCG in TRT [46:00]; Low testosterone: diagnosis, potential causes, treatment options, and other considerations [53:45]; Growth hormone-releasing peptides: rationale and implications of the recent FDA categorization as high-risk substances [1:03:45]; Follistatin gene therapy and myostatin inhibition for increasing muscle mass: the recent hype online, human and animal data, and the need for more research [1:14:45]; Simple tips for lowering calorie intake and losing fat [1:32:30]; Methods of sustainable fat loss with muscle preservation: insights gleaned from bodybuilders [1:40:00]; Could prolonged fasting impact testosterone levels? [1:55:30]; High-protein ice cream [1:57:00]; Exploring fat loss supplements and drugs: L-carnitine, yohimbine, and more [2:02:15]; Potential remedies for individuals experiencing metabolic dysfunction due to hypercortisolemia [2:12:30]; The cornerstones of body composition improvement remain nutrition and exercise, even in the presence of exogenous testosterone [2:19:15]; The importance of approaching health advice found online with a critical eye and a healthy dose of skepticism [2:23:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Alex Aravanis is a leader in research and development of technologies and clinical tests utilizing the latest tools in DNA analysis and data science. In this episode, Alex delves into two interconnected topics: liquid biopsies and epigenetics. He begins by tracing the trajectory of genome sequencing and tumor sequencing, setting the stage for a detailed exploration of liquid biopsies as an early cancer detection method. The discussion encompasses key concepts such as cell-free DNA, DNA methylation, sensitivity, specificity, and the predictive values associated with liquid biopsies. Transitioning to epigenetics, Alex examines the intricate interplay of DNA methylation and aging biology and explores the possibility of using cellular reprogramming to reverse epigenetic changes that occur with aging. We discuss: Alex’s background in applying engineering to problems in medicine [3:15]; A primer on human genetics, and the history and current landscape of DNA sequencing [11:00]; The advent and evolution of liquid biopsies for early detection of cancer [23:15]; The role of cell-free DNA in cancer detection: how incidental findings in non-invasive prenatal testing led to the development of liquid biopsies [40:15]; The development of a universal blood test for cancer detection and a discussion of specificity of tests [46:00]; Advancements in cell-free DNA analysis and development of a multi-cancer screening test at GRAIL [51:00]; DNA methylation explained [58:15]; Optimizing cancer detection with methylation analysis of cfDNA in small blood samples [1:02:45]; The importance of understanding sensitivity, specificity, positive predictive value, and negative predictive value in cancer screening [1:08:00]; The performance of the GRAIL Galleri test and its ability to detect various types and stages of cancer [1:21:00]; Do early cancer detection methods, like liquid biopsies, translate to improvement in overall survival? [1:27:45]; The role of epigenetics in aging [1:39:30]; How cell-free DNA methylation patterns can help identify a cancer’s tissue of origin [1:45:30]; Cellular and epigenetic reprogramming and other exciting work in the field of aging [1:52:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, the conversation focuses on cancer screening, a topic often shrouded in confusion yet crucial to understand given that early identification of a cancer is an essential part of survival strategy. Peter examines the arguments both for and against cancer screening, including addressing why some trials may show no benefit to screening. He then delves into the various screening modalities available for different cancers, highlights the pros and cons associated with each, and explains how to interpret the results. Additionally, Peter provides guidance for navigating outside of the relatively narrow and confined screening guidelines for various types of screening tests. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #56 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Why understanding cancer screening is crucial [2:45]; The prevalence of cancer diagnosis and mortality rates [4:30]; Why cancer screening and early detection is such an important part of the strategy to survive a cancer diagnosis [11:00]; Data on how cancer screening impacts survivability of cancer [16:30]; Inconsistencies between cancer screening trials regarding benefits to survival rates [25:45]; What are some of the reasons why clinical trials don’t always improve cancer-specific mortality? [30:15]; What are the arguments against population-level cancer screening? [42:00]; Cancer screening outside the recommended guidelines: risks and benefits, interpreting results, and other considerations [46:00]; Understanding sensitivity and specificity when reviewing screening results [52:30]; Risks and complications associated with colonoscopies [55:45]; Cancer screening modalities: options for cancer screening both within standard recommendations and beyond [58:30]; The strengths and limitations of various types of cancer screening [1:02:15]; Understanding positive and negative predictive value using sensitivity, specificity, and pretest probability [1:11:45]; Factors that influence an individual's pretest probability of cancer [1:13:45]; How to interpret cancer screening results [1:18:15]; The importance of having an advocate when considering out-of-guideline cancer screening tests [1:23:30]; How stacking multiple cancer screening modalities can decrease the risk of false positives [1:29:30]; Advice and guidance for making decisions related to cancer screening [1:31:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Walter Green is a remarkable philanthropist, mentor, author of This Is the Moment!, and founder of the impactful “Say It Now” movement. In this episode, Walter delves into the unique insights gained from his challenging upbringing, discusses embracing mortality, and highlights the mindset of “finishing strong.” He shares insights on intentionality, thinking in reverse, saying “no,” prioritizing relationships, and the essence of focusing on others. The conversation focuses on the “Say It Now” movement, which stresses the importance of expressing sentiments to loved ones well before the end of life. We discuss: How Peter and Walter met through Ric Elias [2:45]; The unique perspectives and life lessons provided by Walter’s challenging childhood [5:30]; Walter’s harrowing experience with a sudden mental breakdown and his subsequent recovery with the help of therapy [11:15]; A diverse professional journey ending in great success [18:15]; The birth of a movement: celebrating friendships through public tributes and expressing gratitude to those who have shaped your life’s journey [22:30]; Intentionality, thinking in reverse, saying “no”, and other guiding principles for Walter [30:00]; Walter’s global journey of gratitude on his 70th birthday: visiting friends and creating memorable experiences [39:15]; The profound impact of acknowledging and expressing gratitude for the people who contribute to our lives [46:15]; The key elements for creating meaningful connections and cultivating deep, authentic friendships [52:15]; The “Say It Now” movement: the inspiration behind the remarkably impactful initiative [58:30]; What “finishing strong” means to Walter [1:07:30]; Finding peace at the end of life through expressing gratitude and finding purpose in serving others [1:16:00]; Resources to learn about “Say It Now” [1:26:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro Inc. where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling case studies of the successful treatment of complex cases of lower back pain, reinforcing his conviction that nobody needs to suffer endlessly. He also covers the importance of strength and stability, shares his favorite exercises to prescribe to patients, and provides invaluable advice for maintaining a healthy spine. We discuss: Peter’s experience with debilitating back pain [3:30]; Anatomy of the back: spine, discs, facet joints, and common pain points [14:45]; Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more [24:45]; Why the majority of back injuries happen around the L4, L5, and S1 joints [31:00]; How the spine responds to forces like bending and loading, and how it adapts do different athletic activities [36:15]; The pathology of bulging discs [43:15]; The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more [46:00]; The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types [56:15]; The significance of strength and stability in preventing injuries and preserving longevity [1:08:15]; Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns [1:19:30]; Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain [1:30:00]; Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro [1:39:00]; When surgical interventions may be appropriate, and “virtual surgery” as an alternative [1:46:45]; Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more [1:55:30]; Tarlov cysts: treatment and surgical considerations [2:00:15]; The evolution of patient assessments and the limitations of MRI [2:02:15]; Pain relief related to stiffness and muscle bulk through training [2:07:00]; Advice for the young person on how to keep a healthy spine [2:14:15]; Resources for individuals dealing with lower back pain [2:25:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Andrew Huberman, professor of neurobiology at Stanford University and host of the Huberman Lab podcast, returns for another special journal club episode. Andrew introduces an observational study investigating the influence of light exposure on circadian clock regulation and its link to mental health, while Peter covers a phase III clinical trial employing immune checkpoint inhibitors for the treatment of metastatic cancer. They delve into the essential findings of their respective papers, elucidate the reasons for their enthusiasm, and tackle potential limitations and unanswered questions. Additionally, they provide valuable insights into their approaches for comprehending research studies, aiding listeners in independently navigating this process. We discuss: The intricate relationship between light exposure, circadian rhythms, and mental health [3:30]; The importance of low solar angle sunlight, and other types of light needed for optimal mental and physical health [12:00]; Promising new lightbulb technology that simulates low solar angle sunlight [17:45]; The significance of both darkness and the need for direct light exposure to the eyes, specifically [20:00]; Some tips and advice regarding optimizing light exposure, blue blockers, and effects on circadian rhythm [22:15]; Andrew presents a paper which suggests avoiding light at night and seeking light during the day is associated with better mental health [25:45]; Examining the data: the negative impact of increasing nighttime light exposure and the positive effects of daytime light exposure [34:30]; Statistical analysis: the importance of focusing not only on statistical significance but also clinical relevance, power analysis, error bar range, and more [45:45]; Takeaways from the study of daytime and nighttime light exposure [49:45]; The practicalities of minimizing light exposure and screen time at night, the use of sleep trackers, and overall challenge of modern, indoor lifestyles [55:15]; Potential limitations of the light exposure study, reverse causality, and the complex interplay of variables in epidemiological studies [1:06:00]; A tangent on diet soda and sugar substitutes as an example of reverse causality [1:13:15]; Andrew and Peter’s take on the causality vs. correlation of light exposure to mental health, the damage of circadian disruption, and the interpretation of observational data [1:17:30]; A primer on the immune system as background for the paper Peter chose [1:25:00]; Background on cancer: causes, how it evades the immune system, and the logic behind immune checkpoint inhibitor therapy [1:35:45]; Peter presents a paper on immune checkpoint inhibitor therapy in cancer patients [1:50:15]; Unpacking the results of the checkpoint inhibitor trial [1:59:45]; Other noteworthy observations, including the differing results between males and females [2:15:30]; Adverse effects resulting from treatment with an immune checkpoint inhibitor targeting CTLA-4 [2:20:00]; Why melanoma is especially responsive to immunotherapy, and the remarkable success story of immunotherapy for pancreatic cancer [2:25:15]; Why immunotherapy may be the most important hope we have for treating cancer [2:35:30]; Avoiding melanoma: the sunscreen debate, sunburn as the biggest risk factor, and more [2:38:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter delves into the crucial topic of exercise, starting with the importance of having a goal in training, including how and why Peter uses the goal of training for the “Centenarian Decathlon” when structuring his training plans. Peter elaborates on how to identify deficient areas within the four pillars of exercise and guides listeners on incorporating periodization training for optimal improvement and training variety. The episode explores diverse case studies, offering insights into tailored workouts for individuals of various training backgrounds, from seasoned enthusiasts to complete beginners. Additionally, Peter tackles the universal issue of emotional stress and its impact on training, as well as how exercise can help manage stress and how to determine when training should be adjusted during a high-stress period. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #55 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Overview of exercise topics [2:15]; Importance of training with a goal in mind, the Centenarian Decathlon, and the natural decline of fitness with age [4:00]; The four pillars of exercise [12:15]; Measuring peak aerobic output with VO2max, and the importance of VO2max as a predictor of longevity [16:45]; Measuring aerobic efficiency with zone 2 [25:45]; Measuring and tracking muscle mass and strength [27:30]; Case study of a fit person with a neglected pillar: why adding more training volume may not the best strategy [30:30]; Periodization training: what it is and why it is beneficial [36:15]; Periodization case study: high cardio fitness, lacking muscle and strength [40:00]; Periodization case study: adequate muscle, low cardio fitness [44:45]; Case study: significant improvement needed across all exercise pillars [48:45]; Best ways to do zone 2 exercise and how to use relative perceived exertion (RPE) to find your zone 2 level [56:30]; How the body responds to physical and emotional stress, its impact on training, and the consequences of chronic stress [1:01:00]; The difference between “good” stress and “bad” or chronic stress [1:10:30]; The complex relationship between exercise and stress, and the importance of adjusting exercise goals during high-stress periods [1:13:30]; Clues that stress may be impacting your training [1:19:15]; The use of wearables and devices for tracking trends and making decisions related to training [1:21:00]; Parting thoughts regarding the importance of exercise for longevity and stress management [1:32:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Bestselling author Michael Easter returns to The Drive to discuss his new book, Scarcity Brain. In this episode, Michael explores the evolutionary backdrop that molded human beings, a setting characterized by scarce food, limited information, and few possessions. He contrasts that with the modern era, marked by abundance and comfort, and the ensuing repercussions on our physical and mental well-being. Michael introduces the concept of the “scarcity loop,” a three-part behavior cycle which helps explain modern challenges such as overeating, addiction, gambling, and materialism, and offers practical strategies to break free from its cycle. The episode culminates in a thought-provoking exploration of happiness, drawing on Michael's experiences with monks and underscoring the value of boredom, exploration, and discomfort as transformative elements that elevate awareness, presence, and the will to live. We discuss: Inspiration for Michael’s latest book, Scarcity Brain [2:15]; Evolutionary adaptations to the scarcity of food contrasted with the modern obesity crisis [4:00]; Lessons learned about diet and nutrition from living with hunter-gatherers [9:30]; The impact of ultra-processed foods on energy balance [20:30]; Michael’s experience with attempting the hunter-gatherer diet at home [27:30]; The roots of excess: factors that contribute to overeating and the varied vulnerabilities among individuals [34:00]; The scarcity loop: how components of the scarcity loop are illustrated in gambling and addiction [39:45]; Using knowledge of the scarcity loop to break the cycle [50:45]; The evolutionary drive to acquire material possessions [58:15]; The benefits of boredom and value of exploration [1:07:00]; The consequences of an attention economy driven by negativity bias [1:16:30]; Navigating the world of endless information and the value in “slow information” [1:23:00]; Defining happiness, and the downward trend in reports of happiness [1:33:00]; Purpose, austerity, self-reliance and other missing elements of happiness gleaned from the study of monks [1:38:30]; The value in uncomfortable activities that increase your awareness, presence, and will to live [1:48:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter 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 [2:00]; Viewing habits through an evolutionary lens [6:15]; The power of immediate feedback for behavior change, and why we tend to repeat bad habits [9:30]; The role of genetics and innate predispositions in determining one’s work ethic and success in a given discipline [14:45]; How finding one’s passion can cultivate perseverance and discipline [23:30]; Advantages of creating systems and not just setting goals [29:30]; The power of habits combined with self-identity to induce change [36:45]; How a big environmental change or life event can bring on radical behavioral change [50:45]; The influence of one’s social environment on their habits [54:30]; How and why habits are formed [1:00:45]; How to make or break a habit with the “Four Laws of Behavior Change” [1:09:45]; Practical tips for successful behavioral change—the best strategies when starting out [1:16:30]; Self-forgiveness and getting back on track immediately after slipping up [1:30:45]; Law #1: Make it obvious—Strategies for identifying and creating cues to make and break habits [1:40:00]; Law #2: Make it attractive—examples of ways to make a new behavior more attractive [1:48:00]; Law #3: Make it easy—the 2-minute rule [1:59:00]; Law #4: Make it satisfying—rewards and reinforcement [2:03:45]; Advice for helping others to make behavioral changes [2:06:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Colleen Cutcliffe is an expert in molecular biology and co-founder of Pendulum Therapeutics, a company working to develop treatments for a variety of diseases by targeting the microbiome. In this episode, Colleen delves into the complexity of the microbiome, how it is tested, and how it changes over time. She explores how probiotics, prebiotics, and postbiotics affect the gut and makes a compelling case that well-developed products have the potential not only to enhance gut health but also to positively influence overall metabolic well-being. Colleen emphasizes the significance of a high-fiber diet in sustaining a thriving gut microbiome, shares insights on minimizing microbiome damage during antibiotic use, provides tips for fostering and preserving a healthy gut, and much more. We discuss: Colleen’s background and current focus [4:45]; The basics of the microbiome [7:15]; The study of the human microbiome [15:15]; Categories of bacteria, and the implications on health of the rapid evolution of bacteria [19:45]; Methods for measuring and understanding the microbiome, and key indicators of microbiome health [28:30]; The important role of fiber for promoting gut health through the production of butyrate [38:30]; The case for manipulating gut bacteria via fecal microbiota transplant (FMT) [45:00]; Dynamics of the microbiome: the gut-brain connection and how antibiotics, nutrition, stress, and more impact the microbiome's diversity and function [50:15]; Factors that influence the vaginal microbiome [55:15]; The effect of gut microbes on obesity and challenges with fecal transplants in people [58:45]; Beneficial strains of gut bacteria and strains commonly found in probiotics [1:01:15]; The difference between a probiotic and prebiotic, and how CFUs are a measure of the “active ingredient” [1:09:45]; Considerations about how probiotic strains are produced, and more on the meaning of CFU [1:14:15]; Mitigating the effect of antibiotics on the microbiome [1:22:30]; What do we know about the effect of artificial sweeteners on the gut microbiome? [1:30:00]; Why Akkermansia is a keystone strain with implications for metabolic health and an individual’s response to dietary interventions [1:36:15]; The essential steps necessary to develop a robust probiotic for optimal health support [1:45:45]; How Akkermansia helps control blood glucose, and potential implications of Akkermansia in weight loss, diabetes management, and more [1:48:45]; Pendulum Therapeutics’ commitment to rigorous product develop [2:06:30]; Details about the probiotic “Glucose Control” and other probiotics developed by Pendulum Therapeutics [2:13:00]; Further studies of Akkermansia that have been proposed or are underway [2:20:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter tackles essential questions about magnesium, beginning with the important roles it plays in the body and why maintaining proper levels is crucial. Peter discusses the harms of magnesium deficiency, how to determine if you're deficient, potential causes of deficiency, and how diet and supplementation can be used to increase magnesium levels. Peter unravels the confusion surrounding magnesium supplementation, discussing the optimal forms and recommended daily intake while addressing concerns about excess consumption. He also explores the potential cognitive and sleep benefits associated with magnesium supplementation. Finally, Peter concludes with a look into his recent experimentation with new exercises to serve as benchmarks to assess his progress and fitness levels as he navigates the aging process. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #54 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: The important roles of magnesium in the body [2:45]; How to determine if you might be deficient in magnesium [10:15]; Addressing migraines related to low magnesium [14:45]; The prevalence of magnesium deficiency [16:30]; Various conditions and drugs that can negatively impact magnesium levels [21:30]; Magnesium-rich foods and factors that impact absorption of magnesium [24:30]; Daily targets for magnesium supplementation and whether it’s possible to take too much [30:15]; The different forms of supplemental magnesium [34:00]; How absorption of magnesium from food compares to absorption from supplements [36:15]; Choosing the right magnesium supplements for optimal absorption [37:15]; The unique ability of magnesium L-threonate to increase brain magnesium concentration [40:15]; Potential cognitive benefits of magnesium [43:00]; Potential sleep benefits of magnesium [48:45]; Takeaways on magnesium and a look into Peter’s personal protocol [53:15]; Peter’s new benchmarks related to exercise and age [58:30]; and The potential impact of hearing loss on brain health and neurodegeneration [2:04:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Richard Miller is a professor of pathology and the Director of the Center for Aging Research at the University of Michigan, as well as a previous guest on The Drive. In this episode, Rich provides an update on the exciting work of the Interventions Testing Program (ITP), an initiative designed to assess potential life-extending interventions in mice. Rich covers the notable successes like rapamycin, 17⍺-estradiol, and acarbose as well as notable failures like nicotinamide riboside, metformin, and resveratrol, providing valuable lessons about the intricacies of the aging process. Rich delves deep into aging biomarkers and aging rate indicators, unraveling crucial insights into the science of geroprotective molecules. Additionally, Rich discusses some surprising successes of recent molecules tested by the ITP and concludes with an optimistic look at future frontiers, including bridging the gap from mice to humans. We discuss: An overview of the Interventions Testing Program (ITP) [3:45]; How the mice used by the ITP are superior for research relative to mouse models used in most research [11:15]; Design of ITP studies, outcomes tested, and metrics of interest [19:00]; The process and challenges of drug formulation for mice [30:00]; Four drugs identified by the ITP that extends the lifespan of mice [36:30]; The success of rapamycin and what it tells us about the biology of aging [43:15]; Other measures of healthspan evaluated by the ITP in stage 2 studies [50:45]; Distinguishing aging rate indicators from biomarkers of aging [57:30]; Aging rate indicators identified through the examination of slow-aging mice [59:15]; Why proteomics are essential to understand changes in the cell [1:12:15]; Unraveling aging rate indicators: dose-effect, duration, and future frontiers [1:21:45]; A closer look at aging rate indicators: bridging the gap from mice to humans [1:27:00]; What do laboratory mice die from? [1:38:45]; Distinguishing between a drug that improves an age-sensitive outcome and a drug that improves all aspects of aging [1:42:00]; The ITP study of 17⍺-estradiol: mechanisms of life extension and surprising sex differences [1:43:30]; Unsuccessful drugs studied by the ITP: resveratrol, metformin, and nicotinamide riboside [1:51:30]; Over-the-counter successes in the ITP: meclizine and astaxanthin [2:01:00]; A senolytic drug, fisetin, fails to extend lifespan [2:07:00]; Can targeting senescent cells slow aging? [2:13:00]; Optimism about future findings [2:16:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube