Sign in
Health & Fitness
Peter Attia, MD
Expert insight on health, performance, longevity, critical thinking, and pursuing excellence. Dr. Peter Attia (Stanford/Hopkins/NIH-trained MD) talks with leaders in their fields.
#139 - Kristin Neff, Ph.D.: The power of self-compassion
Kristin Neff is a Professor of Educational Psychology at the University of Texas, author, and a leading expert on mindful self-compassion. In this episode, she shares how developing a self-compassion and mindfulness practice was the most effective tool for relieving her own suffering, and provides strategies and tactics to improve self-compassion and well-being. We discuss: The life crisis that turned Kristin to mindfulness and self-compassion (3:30); How mindful self-compassion relieved Kristin’s feelings of self-judgement, and the psychology that says we all have the capacity for self-compassion (9:45); Peter’s history of self-criticism and his personal practice of self-compassion (17:15); The problem with prioritizing self-esteem over self-compassion, and how self-compassion produces a more stable version of self-worth (20:15); An argument for self-compassion over self-criticism for optimizing performance (26:15); How and when to introduce self-compassion to children (31:45); Learning her son had autism—a personal story of how Kristin used mindfulness and self-compassion (36:45); Self-compassion for cases of childhood trauma, PTSD, and overcoming a “fear of compassion” (44:00); The relationship between self-compassion and physical health (49:30); Distinguishing between self-compassion and self-pity, and the three necessary components self-compassion (52:30); Why self-criticism comes from a desire to be safe, the circular pattern of self-judgment, and self-compassion as the ultimate motivator (55:45); Potential role of a self-compassion practice for addiction and other maladaptive behaviors (58:45); Clinical applications and practical uses of self-compassion (1:01:30); Why you don’t need to meditate to learn mindfulness and self-compassion (1:04:45); Kristin’s personal meditation practice (1:08:40); Resources for learning self-compassion (1:11:45); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/kristinneff Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:16:3430/11/2020
#138 - Lauren Miller Rogen and Richard Isaacson, M.D.: Alzheimer’s disease prevention—patient and doctor perspectives
Peter is joined by writer, director, actress, and founder of HFC, Lauren Miller Rogen, and previous podcast guest and director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian, Dr. Richard Isaacson. In this episode, Lauren tells the heartbreaking story of watching members of her family succumb to Alzheimer’s disease (AD) which motivated her to proactively address her own risk with Richard’s guidance. Richard discusses the various genetic and lifestyle factors that influence the risk of AD and uses Lauren’s unique situation to explain how he diagnoses patients and personalizes care. They go through Lauren’s protocol of preventative measures that have already produced marked results, and end with the uplifting message that one’s genetic predisposition does not seal one's fate. We discuss: Lauren’s deep family history of Alzheimer’s disease (3:10); The influence of genetics, epigenetics, and lifestyle on Alzheimer’s disease risk (13:45); Lauren’s mother’s disease progression and the enormous stress it causes for family members (24:30); The various manifestations of Alzheimer’s disease depending on the location of pathology (29:30); The three stages of Alzheimer's disease (34:45); Richard’s deep exploration into Lauren’s family history revealing clues about a diagnosis and a roadmap to successful disease mitigation (39:15); How exercise reduces Alzheimer’s disease risk, and the different risk between males and females (58:00); Why knowing your APOE status is important, and whether certain people should be wearier of head trauma (1:08:00); How Richard uses genetic testing to personalize care (1:14:45); The “ABCs” of Alzheimer’s prevention, lifestyle interventions, and Lauren’s personal protocol for reducing her risk (1:21:45); Unique treatment for people with the ApoE4 variant (1:36:30); Richard’s mixed opinion on CBD and THC as a tool for disease prevention (1:40:00); Cognitive testing procedures, and how Lauren’s tests furthered her commitment to her disease prevention protocol (1:41:45); The relevance of sense of smell and hearing in Alzheimer’s disease risk and prevention (1:50:00); The emotional benefit of knowing you have control over your mental and physical health (1:57:30); HFC—a charitable organization founded by Lauren and Seth (2:00:15); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/laurenmillerrogen-richardisaacson/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
02:11:3923/11/2020
#137 - Paul Offit, M.D.: An expert perspective on COVID-19 vaccines
Paul Offit is a pediatrician specializing in infectious diseases and an expert in virology and vaccine development. He currently serves on the FDA committee overseeing and evaluating COVID-19 vaccines. In this episode, Paul discusses the strategies and major companies pursuing a vaccine against the SARS-CoV-2 virus. He gets into the nuances of the vaccine approval process and its implications for COVID-19 vaccine outlook. Paul also explains potential risks, reveals his own confidence level in safety, and gives insight into protection against reinfection with vaccination. Please note that this episode was recorded 11/05/2020, prior to the 11/09/2020 news release of the Pfizer vaccine update. We discuss: How Paul’s experience as a child in a chronic care hospital as child informed his path in pediatrics and vaccine development (3:30); Addressing the anti-vaccination sentiment and explaining the fraudulent origins of the anti-vaccination movement (8:00); Lessons and insights from 26 years studying rotavirus and creating a successful rotavirus vaccine (17:00); Developing a new vaccine: the different phases of clinical trials, overall timeline, and financial costs (27:15); Operation Warp Speed: the expedited process of creating a coronavirus vaccine (32:30); Various vaccine strategies—RNA, DNA, virus vector—and the challenges associated (35:00); The Moderna and Pfizer mRNA vaccines: strategy, timeline, and Emergency Use Authorization (41:15); Paul’s confidence level in the safety of the first coronavirus vaccines (48:30); The risks associated with different types of vaccines, and updates on the Johnson & Johnson and Astrazeneca coronavirus vaccines (52:15); What we know about the coronavirus vaccines approved in Russia and China (55:45); The latest on the Merck coronavirus vaccine (57:15); The recombinant/purified protein vaccine approach for coronavirus—big players, risks, and the best vaccine for the elderly (57:45); Attenuated and inactivated vaccine strategies for coronavirus (1:02:00); The genetic drift of SARS-CoV-2: Impacts for protection and vaccine development (1:02:30); Paul’s take on the hypothesis that a previous coronavirus infection offers protection against the novel COVID-19 (1:06:45); Addressing the concern that antibodies fade over time (1:09:15); Blood type and protective against coronavirus (1:13:00); Distribution: the challenge of prioritizing the limited doses of vaccines after approval (1:13:15); Paul’s perspective on COVID-19 vaccine safety (1:16:15); Considerations regarding vaccinating children for coronavirus and the role of a fever immune response (1:21:45); Why vaccine development can be challenging and risks of current COVID-19 strategies (1:29:45); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/pauloffit Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:35:5716/11/2020
#136 - AMA #17: Body composition methods tour de force, insulin resistance, and Topo Chico
In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss different methods to evaluate body composition. They explore ways of measuring body fat, delineating between subcutaneous and visceral fat, and go over best strategies for improving body composition and optimizing health. They also discuss insulin resistance using a patient case study that highlights interventions capable of reversing the condition. Finally, Peter addresses his level of concern about a recent Consumer Report finding that Topo Chico had the highest levels of a class of synthetic chemicals (PFAS) of all the carbonated bottled waters tested. Peter concludes by sharing if the finding will change his consumption habits. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #17 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Body mass index (BMI) vs. body fat percentage (BF%) (1:45); Methods of assessing body fat—Magnetic Resonance Imaging (MRI) (6:25); The different types of body fat (9:00); Methods of assessing body fat—Computed Tomography (CT Scan) (12:00); Methods of assessing body fat—Dual-Energy X-ray Absorptiometry (DEXA) (14:30); Methods of assessing body fat—Hydrostatic/Underwater Weighing (19:25); Methods of assessing body fat—Air Displacement (Bod Pod) (22:25); Methods of assessing body fat—Skinfold measurement (23:55); Methods of assessing body fat—Total Body Water (27:15); Methods of assessing body fat—Bioelectrical Impedance (BIA) (28:45); The optimal body fat percentage, muscle mass, and the best strategy to improve body composition (31:30); Defining insulin resistance and the steps to reverse it (40:15); Patient case study: Reversing insulin resistance (49:00); Addressing the recent finding of high levels of PFOA in Topo Chico (58:25); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama17 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
18:0109/11/2020
#135 - BJ Miller, M.D.: How understanding death leads to a better life
BJ Miller is a hospice and palliative care specialist on a quest to reframe our relationship with death. In this episode, BJ begins with how his own brush with death radically shifted his perspective and ultimately forged his path towards palliative care and helping patients integrate and understand their life in a meaningful way. BJ recounts several moving stories from his patients, which reveal important lessons about overcoming the fear of death, letting go of regret, and what’s most important in life. He discusses the major design flaws of a “death phobic” healthcare system. Furthermore, he makes the case that seeing death as a part of life allows us to live well, as opposed to living to evade death itself. He concludes with a discussion around physician-assisted death as well as his hopes around the use of psychedelics to reduce suffering in end-of-life care. We discuss: BJ’s accident leading to the loss of his limbs and his experience inside a burn unit [3:00]; Coping with his amputations—being tough, the grieving process, and the healing properties of tears [14:30]; Going from art history to medical school: the value of a diverse background in medicine [28:15]; How BJ’s new body liberated him [40:00]; How losing his sister to suicide and his disillusionment with medicine altered his path [47:15]; Discovering his path of palliative care—distinct from hospice—in medicine [55:30]; Our complicated relationship with death, and how acknowledging it can release its grip and improve living [1:02:15]; The different distinctions around the fear of death, and how BJ helps his patients negotiate fears [1:10:00]; The major design flaws of a “death phobic” healthcare system [1:14:15]; Common regrets, the value of time, and other insights from interactions with patients in their final moments of life [1:23:00]; The story of Randy Sloan—a case study of playing life out [1:33:45]; Physician-assisted dying: Legality and considerations [1:39:45]; The use of psychedelics in end-of-life care, and what BJ is most excited about going forward [1:45:45]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/bjmiller Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:54:4302/11/2020
#134 - James O’Keefe, M.D.: Preventing cardiovascular disease and the risk of too much exercise.
James O’Keefe is a preventative cardiologist and bestselling author of The Forever Young Diet and Lifestyle. In this episode, James discusses cardiac physiology and what makes the human heart susceptible to disease. He provides evidence for what supports his approach to exercise--elucidating both positive and negative kinds of exercise for heart health. He also discusses the role of nutrition, specific nutrients, and pharmacological interventions to support heart and brain longevity. We discuss: James’ background and why he favors a preventative approach to cardiology [3:15]; Understanding atherosclerosis and the misconception that it’s a “plumbing problem” [10:15]; The danger in excessive exercise—a reverse J-shaped mortality curve [21:15]; The story of Micah True—A case study of excessive exercise [49:15]; The best kinds of exercise for longevity—The Copenhagen City Heart Study [53:00]; Being a more balanced athlete and finding the right exercise intensity [58:45]; Heart rate during exercise, resting heart rate, and other important metrics [1:04:00]; Nutrition for cardiovascular health [1:09:45]; Important nutrients: Magnesium, potassium, calcium, sodium, and collagen [1:19:30]; SGLT2 inhibition for diabetes, cardio-protection, and general longevity [1:24:15]; GLP-1 agonists for weight loss and reducing cardiovascular risk [1:34:15]; Statins—Mechanism of action, safety, and useful alternatives [1:37:25]; A 40-year view on cardiovascular risk, and the possibility of reversing arterial calcification [1:45:45]; Evidence for high dose EPA and DHA for the reduction of cardiovascular disease risk [1:53:30]; The impact of omega-3, curcumin, and other compounds on mental health and dementia [1:59:00]; James’ focus beyond cardiology [2:02:15]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/JamesOKeefe Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
02:09:1726/10/2020
#133 - Vinay Prasad, M.D., M.P.H: Hallmarks of successful cancer policy
Vinay Prasad is a practicing hematologist-oncologist who doubles as a “meta-researcher,” studying the quality of medical evidence, health policy, and clinical trials. In this episode, Vinay discusses the differences in clinical treatment from the existing medical evidence, often leading to useless, or even harmful, outcomes for patients. With a focus in oncology, he takes a deep dive into the field’s structural problems, which include the disconnect between progress and funding, drug costs, and financial conflicts of interest. He concludes with his “six hallmarks of successful cancer policy” as a potential roadmap to sustained progress against cancer and a way to avoid repeating the policy and practice mistakes of the past. We discuss: Vinay’s background and unique perspective [3:15]; Medical reversal—the disconnect between research findings and clinical applications in medicine [10:15]; The uniquely challenging field of oncology [22:45]; The importance of bedside manner with cancer patients [30:00]; Structural problems in oncology—Problem #1: Huge costs for small improvements [37:00]; Structural problems in oncology—Problem #2: Medical reversal—when medical practices are adopted based on low levels of evidence [40:15]; Structural problems in oncology—Problem #3: Slow progress in cancer research (despite all the hype and propaganda) [45:00]; Structural problems in oncology—Problem #4: The burden of payment is not matched with those making treatment decisions [54:45]; “No-brainer” moves in oncology [1:06:45]; “Fool’s gold” treatments in oncology [1:09:30]; The six hallmarks of successful cancer policy [1:16:00]; Cancer policy hallmark #1: Independence [1:18:00]; Cancer policy hallmark #2: Evidence [1:28:15]; Cancer policy hallmark #3: Relevance [1:31:30]; Cancer policy hallmark #4: Affordability [1:32:00]; Cancer policy hallmark #5: Possibility [1:47:00]; Cancer policy hallmark #6: Agenda [1:52:00]; Tumor genome sequencing and liquid biopsies [1:54:30]; Vinay’s clinical philosophy, being skeptical without being too contrarian, and practicing medicine without perfect information [2:03:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/VinayPrasad Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
02:12:0419/10/2020
#132 - AMA #16: Exploring hot and cold therapy
In this “Ask Me Anything” (AMA) episode, Peter and Bob explore the quality of evidence for hot and cold therapy. In the discussion, they evaluate the safety, efficacy, and opportunity costs of various hot and cold therapy protocols, and Peter ultimately considers the addition of dry sauna to his longevity toolkit. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #16 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: How stress can show up as physical pain, and tips for changing time zones [1:45]; Literature overview of heat and cold therapy [7:15]; Cold therapy for delayed onset muscle soreness (DOMS) [12:00]; Quality of evidence for cold therapy for depression or immune enhancement [19:30]; Cold therapy and brown adipose tissue (BAT) [21:15]; Weighing the safety, efficacy, and opportunity cost of cold therapy [28:45]; An overview of heat therapy benefits [40:00]; Longevity benefits of sauna—reviewing the studies [41:30]; Limitations in the sauna literature—Where might we be fooled? [54:30]; Possible mechanisms conferring the longevity benefits of sauna, and how it compares to exercise [1:02:15]; Parting thoughts on sauna, opportunity costs, and Bob’s personal regimen [1:06:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama16/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
19:2112/10/2020
#131 - Beth Lewis: The Art of Stability: Learning about pain, mitigating injury, and moving better through life
Beth Lewis is a former professional dancer and a self-described “educator of movement” who has an unmatched ability to assimilate information and customize training plans from multiple training systems. In this episode, Beth takes us through how she identifies problematic movement patterns and postures to help individuals relieve pain, avoid injury, and move better within all types of exercise. She explains how movement is in fact a trainable skill and provides suggestions for what people can add to their exercise routine to benefit their health and longevity. We discuss: Beth’s “way of no way” training philosophy [4:45] Beth’s background in dancing and how she ended up in New York City [7:30] Beth’s transition to fitness coaching and how her training philosophy has evolved [12:45]; Functional Range Conditioning and scapular mobility [21:50]; An overview of Postural Restoration Institute and Peter’s squat assessment [35:30]; The important connection between the ribs and breathing [39:45]; The role of sitting and external stress in chronic muscular tension [42:30]; The important role of your toes, minimalist footwear, and toe yoga [44:30]; Dynamic Neuromuscular Stabilization (DNS) [48:30]; A different view on knee valgus [52:45]; Is there such a thing as “bad posture”? [56:30]; How Beth identifies an issue, addresses it, and keeps clients motivated [58:45]; Lifting weights, the Centenarian Olympics, and dancing into old age [1:11:00]; The importance of the hamstrings versus abs [1:21:15]; Benefits of rowing, and why everyone should add it to their exercise regimen [1:27:15] Different roles of concentric versus eccentric strength [1:35:15]; Flexibility and high-intensity interval training (HIIT) [1:39:40]; Training versus playing sports, and the best type of activity for kids [1:43:00]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/bethlewis Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:51:0605/10/2020
#130 - Carol Tavris, Ph.D. & Elliot Aronson, Ph.D.: Recognizing and overcoming cognitive dissonance
Renowned social psychologists Carol Tavris and Elliot Aronson are the co-authors of Mistakes Were Made (But Not By Me), a book which explores the science of cognitive biases and discusses how the human brain is wired for self-justification. In this episode, Carol and Elliot discuss how our desire to reconcile mental conflicts adversely affects many aspects of society. The two give real-world examples to demonstrate the pitfalls in attempts to reduce mental conflict, or dissonance. The examples reveal that no one is immune to dissonance reduction behavior, how intellectual honesty can be trained and lastly, how to think critically in order to avoid engaging in harmful dissonant behaviors. We discuss: Carol and Elliot’s respective background, collaboration history, and their decision to write Mistakes Were Made (But Not By Me) [4:00]; The theory of cognitive dissonance, and real examples of dissonance reduction in action [11:15]; How Elliot advanced the theory of cognitive dissonance [23:00]; The evolutionary reason for dissonance reduction, and cultural differences in what causes cognitive dissonance [30:30]; The great danger of smart, powerful people engaging in dissonance reduction [35:15]; Two case studies of cognitive dissonance in criminal justice [39:30]; The McMartin preschool case study—The danger in making judgements before knowing all the information [43:30]; How ideology distorts science and public opinion [56:30]; How time distorts memories [58:30]; The downside of certainty [1:05:30]; Are we all doomed to cognitive dissonance?—How two people with similar beliefs can diverge [1:09:00]; Cognitive dissonance in the police force [1:21:00]; A toolkit for overcoming cognitive dissonance [1:27:30]; Importance of separating identity from beliefs, thinking critically, & and the difficulty posed by political polarity [1:30:30]; How to impart the lessons from their work into future generations [1:48:00]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/caroltavris-elliotaronson/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:59:4428/09/2020
#129 - Tom Dayspring, M.D.: The latest insights into cardiovascular disease and lipidology
World-renowned lipidologist Tom Dayspring returns to give an update on the current thinking in lipidology as a follow-up to his 2018 five-part podcast series. In this episode, Tom discusses the growing consensus that atherogenic lipoproteins are essential drivers of atherosclerotic vascular disease. Tom further emphasizes apolipoprotein B (apoB) and lipoprotein(a) (Lp(a)). He provides insights into risk assessment, including which lab metrics to use, how to interpret them, and the appropriate therapeutic targets. Additionally, Tom discusses the most recent developments in lipid-lowering drug therapies—from the continued evolution of PCSK9 inhibitors, to the latest understanding of EPA and DHA, and the most recent addition of bempedoic acid to the list of therapeutic agents. We discuss: The latest in the field of lipidology and cardiovascular disease [3:45]; Apolipoproteins—the key to understanding lipid biology [9:30]; ApoB as a preferred metric over LDL-P [16:30]; Therapeutic goals for apoB concentration [21:45]; Drivers of atherosclerosis [34:15]; Overview and current thinking on high density lipoproteins (HDLs)—Is it a useful metric? [37:00]; Lipoprotein(a)—the most dangerous particle you’ve never heard of [55:00]; Are low density lipoprotein triglycerides (LDL-TGs) a useful metric? [1:13:15]; Tom’s preferred lab measurements [1:17:45]; The latest in lipid-lowering therapies [1:21:30]; The different pathways among various lipid-lowering drugs [1:30:45]; The latest on EPA and DHA [1:38:15]; Fibrates—an underappreciated treatment for hypercholesterolemia [1:49:45] and; More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/tomdayspring6 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
02:00:0421/09/2020
#128 – Irene Davis, Ph.D.: The evolution of the foot, running injuries, and minimalist shoes
Irene Davis is the founding Director of the Spaulding National Running Center at the Harvard Medical School. In this episode, Irene describes how her research of biomechanics and clinical work with running injuries, as well as research by others, has shaped her views on maintaining body alignment and foot health. Irene discusses her argument for the role of modern footwear in running-related injuries and how minimalist footwear helps resolve the subsequent biomechanical issues. We discuss: Irene’s path to her Ph.D., her entry into physical therapy, and her interest in biomechanics [3:20]; How Irene’s thinking about the use of orthotics has changed [7:15]; The evolution of the human foot and the transition from walking to running [10:30]; The evolution of shoes and its impact on running injuries [17:30]; An overview of running injuries [26:00]; Cushioned running shoes, heel striking and impact forces [29:30]; Shin splints [33:45]; How heel strike patterns promotes knee stress through rate of loading [35:30]; The critical importance of exercise [42:15]; Impact forces and injury potential [45:45]; How shoe cushioning alters impact forces despite forefoot striking [49:00]; An overview of minimalist shoes [52:30]; Irene’s protocol for transitioning people out of orthotics [58:45]; Transitioning to minimalist shoes and a forefoot strike [1:05:30]; Foot muscle volume, minimalist shoes, and orthotics [1:07:00]; The recognition of the importance of foot strength in podiatry [1:09:45]; Minimalist shoes across the lifespan—from children to adults [1:12:30]; Why learning to forefoot strike on soft surfaces is not the best approach [1:20:00]; Knee valgus and factors related to knee injury [1:21:45]; IT band syndrome [1:28:30]; Physics and ground reaction forces [1:33:15]; Irene’s approach to retraining a runner’s gait [1:36:00]; Case study—How the transition to minimalist shoes decreased injury and improved performance [1:42:15]; Importance of proper movement patterns and the negative influence of our modern environment [1:45:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/irenedavis Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:53:0614/09/2020
#127 - AMA #3 with sleep expert, Matthew Walker, Ph.D.: Fasting, gut health, blue light, caffeine, REM sleep, and more
In this special episode, Matthew Walker returns for his third AMA episode to provide his expert insight into numerous sleep-related questions directly from listeners. He explains how he adjusted his hypotheses on topics like blue light and caffeine, and why he is more bullish on the importance of REM sleep. Matt also answers questions about sleep wearables, how fasting affects sleep, how sleep deprivation impacts gut health, and magnesium as a sleep aid. Finally, Matt reveals what he believes is the next evolution in sleep science and technology. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website on the show notes page. We discuss: Matt’s framework for changing his mind when faced with new information [1:30]; Blue light—How Matt shifted his thinking [5:45]; Caffeine—How Matt has adjusted his hypothesis [12:00]; REM sleep—Why Matt is more bullish on the importance of dream sleep [16:30]; How to increase REM sleep [27:30]; Sleep tracking wearables—criteria for evaluation, and why Matthew favors Oura [35:00]; Does the electromagnetic force of devices have any impact on sleep? [40:15]; The relationship between fasting and sleep [46:15]; Restless leg syndrome [58:10]; Magnesium supplementation as a sleep aid [1:03:00]; The relationship between sleep deprivation and gut health [1:08:30]; The next evolution in sleep science and technology [1:16:30]; Questions Matt would like to explore if money was no issue [1:24:15]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/matthewwalkerama3 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
15:3407/09/2020
#126 – Matthew Walker, Ph.D.: Sleep and immune function, chronotypes, hygiene tips, and addressing questions about his book
In this episode, sleep expert Matthew Walker returns by popular demand to dive deeper into many sleep-related topics, starting with what we’ve learned about sleep through the lens of the COVID-19 pandemic and how sleep impacts the immune system. He then covers topics such as how dreaming affects emotional health, the different sleep chronotypes, the best sleep hygiene tips, and the pros and cons of napping. Matthew finishes by addressing several of the errors that readers have pointed out in his book, Why We Sleep. We discuss: Three ways the coronavirus pandemic impacts sleep [3:30]; The importance of dreaming for emotional health, and how the coronavirus pandemic increases dreaming [11:45]; The impact of alcohol consumption on sleep quality and stress levels [20:00]; Sleep’s impact on the immune system and implications for a future COVID-19 vaccine [27:45]; What determines how much deep sleep and REM sleep you need? [36:30]; Pros and cons of napping, and insights from the sleep habits of hunter-gatherer tribes [42:15]; Sleep hygiene, wind-down routine, and tips for better sleep [56:45]; Understanding sleep chronotypes and how knowing yours can help you [1:06:00]; Night terrors in kids—what they are and why they happen [1:16:30]; Addressing errors found in Matt’s book, Why We Sleep [1:20:45]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/matthewwalker4 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:41:5331/08/2020
#125 - John Arnold: The most prolific philanthropist you may not have heard of
John Arnold is widely regarded as the greatest natural gas trader of all time, but in his late 30’s he walked away from it all and turned full-time philanthropist. He and his wife have committed to strategically give away most of their vast fortune in their lifetime and are already doing so at a staggering pace of nearly a half billion dollars a year. In this episode, John explains his quest to address the most challenging social programs plaguing the country, including criminal justice, health care policy, and K-12 education. John also shares self-identified attributes that contributed to his success in natural gas trading and how those same traits have translated to his philanthropic aspirations. We discuss: John’s background, upbringing, and early entrepreneurial tendencies [3:50]; John’s time and rise at Enron [16:45]; Characteristics that made John an exceptional natural gas trader and how they translate to his philanthropic work [27:30]; The collapse of Enron [35:00]; The success of John’s hedge fund, and his early interest in philanthropy [40:30]; The infamous 2006 trade that brought down Amaranth Advisors [55:45]; John’s analytical prowess and emphasis on fundamentals [1:02:15]; The decision to become a full-time philanthropist and the founding of Arnold Ventures [1:09:00]; Education—John’s quest to fundamentally change K-12 education [1:18:45]; Strategic philanthropy—preventing problems by attacking root causes and creating structural change [1:24:30]; The criminal justice system—structural changes needed to address mass incarceration, policing practices, and recidivism [1:31:45]; Re-imagining prisons to reduce recidivism [1:49:00]; US health care policy—John’s focus on drug prices, and the severe consequences of not making system changes [1:56:15]; Climate change—the bipartisan role of John’s foundation [2:13:45]; Advice for young adults interested in philanthropy [2:17:45]; and More Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/JohnArnold Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
02:28:2624/08/2020
#124 - AMA #15: Real-world case studies—metabolic dysregulation, low testosterone, menopause, and more
As a follow up to AMA #14 where Peter explained his framework for analyzing labs, this “Ask Me Anything” (AMA) episode focuses on a number of real-world case studies exploring metabolic dysregulation, low testosterone, menopause, hypothyroidism, elevated uric acid, and more. From the examples discussed, you can follow along how our clinical team goes about interpreting diagnostic measures and applying relevant research findings. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #15 show notes page. We discuss: Should you stop taking supplements before getting a lab test? [2:45]; Family history—Questions to ask and what to look for [5:30]; The purpose of an oral glucose tolerance test (OGTT) [12:15]; Case study—Insufficient muscle mass for proper glucose disposal [17:15]; Why hemoglobin A1c is a relatively unhelpful metric [24:00]; Case study—Exceeding carbohydrate tolerance [26:30]; Case study—Metabolic dysfunction and a framework for metabolic health [33:30]; Peter’s ideal tracking of metabolic health for all his patients [43:30]; Contrasting presentations of hypogonadism—Low free testosterone [45:00]; How sleep, exercise, and alcohol affect testosterone levels? [56:20]; Case study—Surprisingly fast onset of menopause [59:25]; Case study—Hypothyroidism and high cholesterol [1:07:00]; Case study—Elevated uric acid and hypertension [1:10:55]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama15 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
16:4917/08/2020
#123 - Joan Mannick, M.D. & Nir Barzilai, M.D.: Rapamycin and metformin—longevity, immune enhancement, and COVID-19
In this episode, Joan and Nir discuss their extensive research into rapamycin (including the category of analogs to rapamycin known as rapalogs) and metformin, respectively. Based on his work with metformin, Nir shares how he believes it could be a pro-longevity drug and the clinical trial he’s leading to test this belief. Joan discusses her work with rapalogs, their ability to suppress the immune system as well as provide immune-enhancement, and the clinical trials she has led that inform her insights. We also talk about the potential beneficial roles of both metformin and rapamycin in reducing mortality from COVID-19, reducing the risk of neurodegenerative diseases, and delaying aging as well as its related diseases. We discuss: Joan’s career, interest in aging, and work with rapamycin analogs [3:45]; When Nir became convinced metformin could be a pro-longevity agent [15:00]; How metformin and rapamycin impact the hallmarks of aging and extend lifespan [24:15]; Enhancing the immune system with rapalogs and metformin [34:15]; Potential of metformin and rapamycin in reducing mortality from COVID-19 [41:30]; Insights from Joan’s studies investigating the immune-enhancing effects of rapalogs [59:30]; Vaccines and treatments strategies for COVID-19, and the likelihood of long-term immunity [1:08:15]; The potential role of rapalogs and metformin in neurodegenerative disease [1:14:30]; Nir’s TAME trial—primary objectives and latest updates [1:18:00]; Potential synergistic effect when combining metformin with rapamycin [1:25:45]; Why Peter stopped taking metformin and started taking rapamycin [1:27:30]; Story from Nir’s book that demonstrates the challenge of doing good scientific studies [1:37:30]; The biology of aging—epigenetic clocks, proteomics, and Nir’s centenarian data [1:42:00]; Joan’s dream experiment to test immune-enhancing effect of RTB101 [1:57:15]; Concluding thoughts on COVID-19 [1:59:45]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: http://peterattiamd.com/joanmannick-nirbarzilai/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
02:17:5910/08/2020
#122 - Lori Gottlieb: Understanding pain, therapeutic breakthroughs, and keys to enduring emotional health
Lori Gottlieb is a psychotherapist and the bestselling author of Maybe You Should Talk to Someone. In this episode, Lori extracts important lessons from her experiences as both a therapist and a patient. The stories Lori shares has provided her the material for insights into living a more fulfilling life. In our conversation, Lori also dispels some misconceptions about therapy, explains the process of big therapeutic breakthroughs, and reveals the most important steps for enduring emotional health. We discuss: Lori’s unique path to becoming a therapist [3:00]; Dissecting cadavers—a profound experience during med school [12:30]; The sunk cost fallacy—How Lori was able to walk away from med school [17:15]; Being aware of the gift of life, and other lessons from Lori’s terminally ill patient [24:00]; How underlying pain can manifest in obnoxious behavior [32:45]; Counseling versus therapy [36:15]; The story of John—why men hide their feelings, breaking down his shield, and uncovering his pain [38:30]; “Breaking open”—A shocking revelation about John that tests Lori’s resolve as a therapist [46:30]; Rewriting your story, the recovery process, and the most important step for lasting change [49:00]; The process of many big therapeutic breakthroughs [56:00]; The 2 types of suicidal thoughts, and the importance of talking about it [1:01:00]; The most common issues that bring patients to therapy with Lori [1:02:45]; Clinging to the familiar—why change is so hard [1:05:15]; A story of shame, lack of self-compassion, and self-sabotage [1:07:00]; The importance of managing mental health to reduce unnecessary suffering [1:15:45]; Dispelling the misconceptions about therapy [1:23:15]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/LoriGottlieb Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:30:1203/08/2020
#121 - Azra Raza, M.D.: Why we're losing the war on cancer
Azra Raza is a physician, scientist, author, and outspoken advocate for reconfiguring the current model of research in cancer. In this episode, Azra discusses the content of her book, The First Cell, which takes a critical look at the outdated models being used to study cancer resulting in a lack of progress in survival rates for cancer patients. Azra offers a solution which focuses on early detection and prevention, and she concludes with an optimistic outlook for the future of cancer research. We discuss: Azra’s upbringing, interest in oncology, and the basis for writing her book [3:30]; The lack of progress in cancer treatment over the decades [18:45]; What is holding the oncology field back? [33:15]; Do the purported advances in oncology reflect the billions of dollars spent on cancer research? [40:00]; Economics of new cancer drugs—how small increases in survival come with staggering financial burdens [47:00]; How good intentions can still lead to misaligned incentives and a broken system [1:03:00]; Why 95% of new cancer drugs fail—a critical review of the cancer research model [1:11:15]; Early detection and prevention—a potential solution to the cancer problem [1:22:30]; Coping with the loss of her husband to cancer [1:46:00]; Azra’s optimistic view of the future [1:49:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/azraraza Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:54:5527/07/2020
#120 - AMA with Dom D’Agostino, Ph.D., Part II of II: Ketosis for cancer and chronic disease, hyperbaric oxygen therapy, and the effect of ketosis on female health
In part 2 of this special AMA episode, ketosis expert Dom D’Agostino once again joins Bob Kaplan, Peter’s Head of Research, to discuss the impact of ketosis on various chronic diseases as well as the latest research on the metabolic management of cancer. Dom also discusses the numerous applications of hyperbaric oxygen therapy, provides insights into the application of ketosis on female health and performance, and much more. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on the website show notes page. We discuss: Update on Dom’s Press-pulse therapeutic strategy for the metabolic management of cancer [2:05]; Potential role for vitamin C in cancer treatment [12:45]; Glutamine targeting in cancer therapy—evidence that the mitochondria in cancer are damaged? [17:45]; Can a ketogenic diet lessen the toxicity of cancer therapies? [24:45]; 3BP—a promising agent in cancer therapy [26:45]; The relationship between cancer and ketogenic diets [29:30]; Hyperbaric oxygen therapy (HBOT)—primer, protocols, and therapeutic uses [33:30]; Is there a potential role for HBOT in treating COVID-19 patients? [44:15]; Non-cancer applications of HBOT [47:30]; The inverse relationship between glucose and ketones [50:30]; Is a ketogenic diet appropriate for type 1 diabetics? [54:00]; How ketosis may reduce the risk for Alzheimer’s disease and Parkinson’s disease [1:00:30]; Ketosis for females—considerations, fertility, performance, and the latest research [1:11:00]; Low-carb diets during pregnancy and postpartum [1:17:00]; A high-protein diet to counteract common hormonal issues associated with the ketogenic diet [1:21:15]; Nutritional tips for remaining metabolically flexible [1:22:45]; What is one belief Dom has changed his mind about? [1:26:45]; In utero experiments, and other interesting questions Dom wants to explore [1:29:45]; The anti-catabolic effect of ketones, cancer cachexia, and nutritional interventions for cancer patients [1:38:30]; What is the one interesting experiment Dom would do if money and time were not a barrier? [1:46:25]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/domdagostinoama02/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
28:2720/07/2020
#119 - Terry Real: Breaking the cycle of shame, anger, and depression
Terry Real, a renowned family therapist and best-selling author, helps people create the connections they desire in their relationships. In this episode, Terry describes how his upbringing with an abusive father forged his path to become a therapist, develop his Relational Life Therapy (RLT) framework, and write I Don't Want to Talk About It—a book that reveals the hidden legacy of male depression. Terry discusses the link between childhood trauma and the deep-rooted shame, anger, and depression, which can result in feeling disconnected. Using real-life examples, Terry explains how he implements RLT to confront trauma, discover its origin, and teach the skills to break the cycle of pain, in order to live a satisfying life. We discuss: Terry’s upbringing with a depressed and abusive father [3:15]; The importance of the repair process, after relational disharmony, to break the trauma cycle [15:15]; The impact of a patriarchal society, and relational growth as the next step for feminism [19:00]; Origins of deep-rooted shame, and the difference between feeling ashamed and feeling guilty [27:15]; Preventing the propagation of trauma without over-coddling kids [35:30]; The one-up/one-down cycle from grandiosity to shame [37:30]; Covert depression—Steps to fixing the secret legacy of male depression [40:00]; Three forms of false self-esteem [50:00]; Narcissism—A misunderstood concept [51:45]; The interplay of shame, anger, and grandiosity, and how to break the cycle [54:15]; The Relational Life Therapy framework [1:06:30]; How the adaptive child becomes the maladaptive adult [1:15:30]; Speaking the language of social relationships [1:21:45]; When does it make sense for a couple to separate? [1:26:30]; Witness abuse—Consequences of screaming at your partner in the presence of children [1:28:15]; Cases of instantaneous change, and other behavioral changes that may take more time [1:30:45]; Reconciling with his father—Terry’s final conversation with his dad [1:33:45]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/terryreal Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:39:4613/07/2020
#118 - Lloyd Klickstein, M.D., Ph.D.: Rapamycin, mTOR inhibition, and the biology of aging
Lloyd Klickstein is the Chief Science Officer at resTORbio, a biopharmaceutical company that develops medications to target the biology of aging. In this episode, Lloyd discusses his company’s clinical application of rapamycin and its derivatives. He also elucidates details of his 2014 paper—a paper that greatly influenced Peter’s perspective of rapamycin in the context of longevity. Peter and Lloyd go on to discuss the dose-dependent effect of rapamycin on immune function and compare rapamycin, fasting, and caloric restriction. We discuss: His background and decision to leave academia for translational medicine [6:15]; Translational medicine—bridging the gap between basic science and clinical medicine [10:30]; What prompted Lloyd to focus on mTOR inhibition? [18:00]; Defining mTOR, TORC1, and TORC2, and the consequences of inhibiting them with rapamycin [21:30]; Dose-dependent impact of rapamycin on immune function, mTOR inhibition, and toxicity [42:15]; Lloyd’s 2014 experiment—mTOR inhibition improves immune function in the elderly [53:00]; Insights into autophagy, antigen presentation, and the pleiotropic benefits of a rapalog, and how it compares to fasting [1:13:00]; Lloyd’s 2018 experiment—TORC1 inhibition enhances immune function and reduces infections in the elderly [1:18:45]; Creation of resTORbio, subsequent studies, and takeaways about dosing, TORC2 inhibition, and tissue selectivity [1:29:00]; Comparing the longevity effect of rapamycin, fasting, and caloric restriction [1:40:00]; Excitement around RTB101—resTORbio’s mTOR inhibiting molecule [1:47:00]; Identifying rapalogs selective for TORC1 [1:56:15]; Treating depression with ketamine, an activator of mTOR [2:00:00]; Epigenetic clocks, rapalogs, and metformin [2:03:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/LloydKlickstein Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
02:14:5506/07/2020
#117 - Stanley Perlman, M.D., Ph.D.: Insights from a coronavirus expert on COVID-19
In this episode, Stanley Perlman shares insights from his impressive career studying coronaviruses—both the common and more deadly ones, like MERS and SARS. In comparing preceding coronaviruses with SARS-CoV-2, Stanley discusses how other coronaviruses can aid our current understanding of, and be used to infer about, COVID-19. He also gives his thoughts on durable immunity, therapeutic strategies, and future outbreak preparedness. We discuss: His background and early work with coronaviruses [2:45]; The coronavirus family—various types, common traits, and scientific understanding [9:00]; The origin of viruses, animal to human transmission, R_0, immunity, and more [17:45]; Insights from the 2002 SARS outbreak [28:30]; Insights from the 2012 MERS outbreak [35:00]; Comparing SARS-CoV-2 to MERS, SARS, and other coronaviruses [42:00]; COVID-19 survivor potential for long-term damage [53:30]; Using the current pandemic for lessons on future preparedness [57:00]; Genetic drift and the potential for long-term immunity to COVID-19 [1:07:00]; Prevention and treatment strategies for COVID-19 and future diseases [1:22:30]; Alternative hypothesis to the origin of SARS-CoV-2 [1:32:30]; Determining durable immunity to COVID-19 and what a successful vaccine looks like [1:34:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/stanleyperlman Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:43:5629/06/2020
#116 - AMA with Dom D’Agostino, Ph.D., Part I of II: Ketogenic diet, exogenous ketones, and exercise
Back by very popular demand for a special AMA episode, ketosis expert Dom D’Agostino joins Bob Kaplan, Peter’s Head of Research, to address many lingering questions about the ketogenic diet, exogenous ketones, and exercise for overall health. Dom also shares valuable insights from his personal experience with training, supplements, intermittent fasting, and other nutritional strategies to optimize his own health and performance. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on the website show notes page. We discuss: Dom’s recent and ongoing projects [3:00]; Benefits of a ketogenic diet for an otherwise healthy person [7:00]; Book recommendations to become more knowledgeable about a ketogenic diet [11:30]; Best devices for measuring ketones [13:45]; Genetic factors that influence how someone responds to the ketogenic diet [24:45]; Ketogenic diet for those with the APOE e4 allele [28:15]; Impact of long-term ketogenic diets on thyroid function [34:25]; Low-carb and ketogenic diets for appetite control and weight management [39:00]; Ketogenic diet and the microbiome [43:00]; Comparing monounsaturated fat versus saturated fat on the ketogenic diet [45:55]; Implications of long-term genetic and epigenetic adaptations to a ketogenic diet [47:45]; Why some people see a rise in LDL-C and LDL-P when on a ketogenic diet and what they can do about it [50:15]; Should someone with familial hypercholesterolemia consider a ketogenic diet? [55:00]; Exogenous ketones—benefits, therapeutic uses, and ketone supplements that Dom has tested [56:45]; Ketogenic protocols for management of traumatic brain injuries [1:06:00]; Comparing the benefits and therapeutic uses of various medium-chain fatty acids—caprylic acid (C8), capric acid (C10), MCT oil, and coconut oil [1:08:45]; Nootropics, caffeine, and other stimulants [1:16:15]; Supplemental use of testosterone, DHEA, and creatine for muscle growth and performance [1:23:45]; Impact of fasted-state training on strength and performance [1:30:15]; Stacking exogenous ketones with MCTs for optimal effectiveness [1:33:30]; BCAA supplements during a fast for muscle preservation [1:35:45]; What app is Dom using to track his macros? [1:42:00]; Getting enough micronutrients while on a ketogenic diet [1:47:15]; Ideal macros and getting enough protein for strength training in ketosis [1:48:15]; Pros, cons, and ideal macros of one meal a day [1:51:15]; Dom’s take on “carb backloading” [1:54:45]; Dom’s take on “carb up” days for ketogenic dieters [2:01:00]; Dom’s thoughts on the carnivore diet and the paleolithic ketogenic diet [2:05:30]; Advantages of the ketogenic diet for extreme endurance athletes [2:10:30]; Impact on strength, power, and performance during the adaptation period of the ketogenic diet [2:14:00]; Fasted-state elevation in growth hormone and its impact on training [2:17:45]; Is it possible to build muscle on a ketogenic diet? [2:23:30]; Why Dom took a year off from weight training [2:28:00]; What does Dom do for cardio exercise? [2:30:45]; Protocols for hard training recovery [2:33:15]; Dom’s personal approach to fasting, time-restricted eating, and sleep [2:35:45]; People, books, and other resources that shaped Dom’s training and nutrition [2:38:45]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/domdagostinoama01 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
28:2722/06/2020
#115 - David Watkins, Ph.D.: A masterclass in immunology, monoclonal antibodies, and vaccine strategies for COVID-19
In this episode, David Watkins, professor of pathology at George Washington University, shares how insights from his HIV and Zika virus research could apply to SARS-CoV-2 protection strategies. David introduces monoclonal antibodies as an intervention to prevent and treat COVID-19 infection, and also discusses how they could be used as a hedge to vaccine development. Additionally, David’s immunology tutorial explains the innate and adaptive immune systems and their differentiated responses to viral infection. We discuss: Background and current interest in immunology [4:30]; Immunology 101—The innate and adaptive immune system [10:15]; Defining antibodies, importance of neutralizing antibodies, and serology testing for COVID-19 [19:00]; B cells—How they fight viruses, create antibodies, and fit into the vaccine strategy [25:00]; T cells—Role in the adaptive immune system and ability to kill infected cells to prevent viral spread [36:15]; Valuable lessons from HIV applied to SARS-CoV-2 [51:00]; Lessons taken from the hepatitis C success story [1:01:30]; Monoclonal antibodies, vaccines, and the most promising strategies for preventing and treating COVID-19 infection [1:04:45]; COVID-19 vaccines in development [1:19:00]; How David’s work with Zika virus informs his thinking on SARS-CoV-2 [1:25:20]; Why a vaccine for COVID-19 doesn’t need to be perfect to be effective [1:27:45]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/davidwatkins Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:37:3215/06/2020
#114 - Eileen White, Ph.D.: Autophagy, fasting, and promising new cancer therapies
In this episode, Eileen White, Chief Scientific Officer at the Rutgers Cancer Institute, describes the fundamental role of autophagy in the maintenance of health and prevention of neurodegeneration, cancer, and other diseases. She also goes into detail about the paradoxical finding that autophagy may benefit an existing cancer cell and help it to survive—a discovery leading to new possibilities in cancer therapy. We also discuss fasting (and molecules that induce autophagy) and the critical need to decode the proper fasting “dose” in order to improve human health. We discuss: Eileen’s discovery that a specific oncogene blocks apoptosis [3:40]; Defining apoptosis and its role in cancer prevention [10:00]; How cancer cells use the autophagy pathway to survive [17:20]; Stressors that induce autophagy [29:15]; The importance of autophagy in the brain and liver [32:45]; The mechanisms that can trigger autophagy to support longevity [40:00]; Evidence for cancer treatment by blocking autophagy [42:30]; Types of cancer that are most autophagy-dependent [46:45]; The autophagy paradox [52:40]; Finding a molecular signal for autophagy [59:15]; Current knowledge gaps around fasting as a tool for longevity [1:13:00]; Rapamycin, metformin, and other molecules that may induce autophagy [1:22:15]; How to study fasting and exercise as longevity tools [1:32:50]; The Nobel Prize for autophagy research [1:36:45]; Eileen’s future areas of research [1:38:25]; A fasting strategy for Alzheimer’s Disease prevention[1:49:25]; Future study of metabolism and autophagy [1:51:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/eileenwhite Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:58:5508/06/2020
#113: Normative errors—a conversation with my daughter about current events
In this episode, I sit down with my daughter to discuss the brutal death of George Floyd, and the aftermath we are watching unfold. Though I have no expertise in race relations, law enforcement, or police brutality, I do have some knowledge in the training of physicians, and it is that training of doctors that I’ve been thinking about lately as it may offer one small insight into this crisis. In this very short discussion, we speak about three types of errors in medicine (and medical training), how to distinguish between the two variants that are acceptable, and the one that is unacceptable. My question, ultimately, is if such a framework can be applied to law enforcement? Learn more: https://peterattiamd.com/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
22:0703/06/2020
#112 - Ned David, Ph.D.: How cellular senescence influences aging, and what we can do about it
Ned David is the co-founder of Unity Biotechnology, a company developing senolytic medicines—molecules that target and destroy senescent cells in the human body. In this episode, Ned explains the science of cellular senescence and how it impacts the aging process. Ned discusses how senolytics may delay, prevent, treat, or even reverse age-related diseases, including cancer, cardiovascular disease, and neurodegenerative disease. As a serial entrepreneur, Ned also provides advice on how to transform a simple idea into the creation of a company. We discuss: Defining longevity and the principles of aging [2:50]; The control knobs of aging and how we can turn them [15:10]; Role of cellular senescence in aging and cancer [27:00]; History of senescence in scientific study [40:30]; The cellular senescence paradox [46:00]; Developing medicines that target cellular senescence [52:15]; Ned’s lessons on risk analysis in business [1:05:15]; The search for a molecule that could eliminate senescent cells [1:15:15]; Senescent cell elimination example in osteoarthritic knees [1:30:30]; Extending lifespan by removing senescent cells [1:45:00]; Senolytic molecule example in macular degeneration reversal [1:52:30]; The future of senescent cell targeting [1:58:30]; The role of cellular senescence and metabolic syndrome [2:01:30]; The role of cellular senescence and brain health [2:03:30] What prepared Ned to start Unity Biotechnology [2:05:45]; Advice for someone deciding between business and academics [2:08:50]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/neddavid Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
02:15:3401/06/2020
#111 - AMA #14: What lab tests can (and cannot) inform us about our overall objective of longevity
In this “Ask Me Anything” (AMA) episode, Peter explains his framework for understanding what lab tests can (and cannot) inform us as it pertains to overall longevity, with a specific focus on atherosclerosis, cancer, Alzheimer’s disease, and the physical body. Additionally, Peter shares details into two patient case studies around cardiovascular disease, including how the lab results influenced his diagnosis and treatment plan for the patients. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #14 show notes page. We discuss: Important lab tests and reference ranges [2:35]; How lab testing fits into the overall objective of longevity [4:25]; A healthcare system set up to react to a disease rather than prevent it [8:00]; The four pillars of chronic disease, and the three components of healthspan [14:30]; Atherosclerosis—How much can labs tell us about risk? [18:00]; Coronary calcium score (CAC)—Interpreting results based on your age [24:15]; Cancer—What lab work can tell you, and the future of liquid biopsies [28:00]; Alzheimer’s disease—What’s driving Alzheimer’s disease, and what labs can tell you about your risk [33:15]; Healthspan and the physical body—Where lab testing fits, the endocrine system, and zone 2 testing [39:00]; Summarizing the usefulness of lab testing—Where it gives great, reasonable, or lousy insight [43:15]; Patient case study—Elevated Lp(a): Understanding ApoB, and how cholesterol levels get reduced [45:30]; Patient case study—Familial hypercholesterolemia [59:30]; Coming up on a future AMA [1:10:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama14 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
17:1118/05/2020
#110 - Lew Cantley, Ph.D.: Cancer metabolism, cancer therapies, and the discovery of PI3K
In this episode, Lew Cantley, Professor of cancer biology and Director of the Sandra and Edward Meyer Cancer Center at Weill Cornell Medical College in NYC, walks us through his amazing discovery of phosphoinositide 3-kinase (PI3K) and the implications for the care of patients with cancer. He explains various combinations of therapies being tested and used, including the possibility of pairing prescriptive nutritional therapies to increase the efficacy of drugs like PI3K inhibitors. Lew also explains the metabolic nature of cancer through the lens of his research into the connection between sugar consumption, insulin resistance, and tumor growth. Additionally, Lew provides some details about his exciting new clinical trial that is just now enrolling patients with stage 4 breast cancer and endometrial cancer. We discuss: Teaching science through the lens of discovery—A better approach to learning science [5:15]; The metabolic nature of cancer, mitochondria, and a more nuanced explanation of the Warburg Effect [8:30]; The observation that convinced Lew to stop eating sugar [20:15]; The connection between obesity, insulin resistance, and cancer [25:30]; Sugar consumption and tumor growth—What did Lew’s 2019 paper find? [32:00]; Natural sugar vs. HFCS, fruit vs. fruit juice, insulin response and cancer growth [43:00]; Increasing efficacy of PI3K inhibitors with ketogenic diets, SGLT2 inhibitors, and metformin [53:30]; Lew’s clinical trial enrolling stage 4 breast cancer and endometrial cancer patients [1:07:30]; Pairing diet with drug could be the future of cancer treatment [1:09:30]; PI3K inhibitors on the market, alpha vs. delta isoform, and the possibility of pairing them with a food prescription [1:16:15]; What questions will Lew be focused on in the next chapter of his career? [1:22:15]; Lew's early work that ultimately led to the discovery of PI3K [1:27:30]; Studying the mechanism by which mitochondria make ATP [1:30:45]; How understanding the mechanism by which insulin drove glucose uptake into a cell got Lew closer to finding PI3K [1:38:15]; How Lew knew PI3K was important in driving the growth of cancer cells [1:55:00]; Lew’s unlikely observation of phosphorylation at the 3' position of the inositol ring resulting in the formation of phosphatidylinositol-3-phosphate [1:59:00]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/lewcantley/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
02:11:2211/05/2020
#109 - John Dudley: The beauty in archery, the love of practice, and a model system for life
In this episode, professional archer, John Dudley, shares the many insights he’s gleaned through the process of not only becoming an elite competitor of archery but also an exceptional teacher. John describes how his desire for improvement has cultivated a sheer love of practice, and how pursuing mastery helped put into context how archery is an amazing model system for life. Additionally, John discusses the often misunderstood nature of hunting, but also makes the case as to why one should consider trying archery even if there is no desire to hunt. We discuss: Why John loves archery, and what it means to be a professional archer [4:50]; How John’s love of practice and training led to archery [10:45]; How an intense desire to improve drove John to quit football and pursue archery [22:00]; A traumatic childhood event that changed John’s course from troublemaker to committed athlete [34:15]; The nuts and bolts of archery—Competitive events, types of bows, hunting, etc. [45:30]; The blissful nature of archery, and the uselessness of anger [57:15]; Hyper-focus and flow states—Did John’s ADD and task-driven personality give him an advantage? [1:07:15]; The common traits found in the most successful people [1:12:45]; The keys to maintaining credibility as a salesman—Integrity, honesty, and straightforwardness [1:18:45]; The coaching technique that makes John a great teacher [1:28:30]; Why you should consider trying archery (even if you never want to hunt) [1:36:15]; Hunting discussion—The morality argument, hunting vs. commercial farming, managing overpopulation, and the unique emotional connection [1:45:00]; Resources for those interested in taking up archery [2:12:00]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/johndudley Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
02:16:3404/05/2020
#108 - AMA #13: 3-day fasting, exogenous ketones, autophagy, and exercise for longevity
In this “Ask Me Anything” (AMA) episode, Peter explains some observations he’s noticed since switching to a 3-day fasting cycle from the longer fasts, the various things he’s measuring, and some helpful tips for getting through a prolonged fast. He also discusses the role of exogenous ketones in fasting and ketogenic diets as well as their impact on autophagy, specifically. Finally, Peter provides some practical advice for those looking to fit exercise for longevity into their busy life. Once again, Bob Kaplan, Peter's head of research, will be asking the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #13 show notes page. If you are not a subscriber, you'll be able to listen to a sneak peak of this episode. We discuss: Peter’s observations since switching from a 7-day to a 3-day fasting regimen [1:25]; Ketone measuring devices—blood and breath [7:40]; Can zero-calorie sweeteners affect ketone production? [10:40]; Will there be a continuous insulin monitor anytime soon? [11:55]; Exogenous ketones—Role in fasting and ketogenic diets and their effect on insulin, blood glucose, and autophagy [14:10]; 5 tips to help you get through a multi-day fast [25:55]; Relationship between BHB levels, glucose levels, and autophagy—Are high levels of ketones enough to produce autophagy? [34:10]; Why is measuring blood insulin so much harder than blood glucose? [36:55]; Advice and resources for people wanting to stay up to date on developments related to health and longevity (and how to quickly sift through all the bad science) [40:10]; Advice for those looking to fit exercise for longevity into their busy life [51:10]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama13 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
15:3021/04/2020
#107 - John Barry: 1918 Spanish flu pandemic—historical account, parallels to today, and lessons
n this episode, John Barry, historian and author of The Great Influenza: The Story of the Deadliest Pandemic in History, describes what happened with the 1918 Spanish flu pandemic, including where it likely originated, how and why it spread, and what may have accounted for the occurrence of three separate waves of the virus, each with different rates of infection and mortality. While the current coronavirus pandemic pales in comparison to the devastation of the Spanish flu, John highlights a number of parallels that can be drawn and lessons to be learned and applied going forward. We discuss: What got John interested in the Spanish flu and led to him writing his book? [2:45]; Historical account of the 1918 Spanish flu—origin, the first wave in the summer of 1918, the death rate, and how it compared to other pandemics [10:30]; Evidence that second wave in the fall of 1918 was a mutation of the same virus, and the immunity immunity protection for those exposed to the first wave [18:00]; What impact did World War I have on the spread and the propagation of a “second wave”? [21:45]; How the government’s response may have impacted the death toll [26:15]; Pathology of the Spanish flu, symptoms, time course, transmissibility, mortality, and how it compares to COVID-19 [29:30]; The deadly second wave—The story of Philadelphia and a government and media in cahoots to downplay the truth [35:50]; What role did social distancing and prior exposure to the first wave play in the differing mortality rates city to city? [44:45]; The importance of being truthful with the public—Is honesty the key to reducing fear and panic to bring a community together and combat the socially-isolating nature of pandemic? [46:15]; Third wave of Spanish flu in the spring of 1919 [51:30]; Global impact of Spanish flu, a high mortality in the younger population, and why India hit so much harder than other countries [55:15]; What happened to the economy and the mental psyche of the public in the years following the pandemic? [59:20]; Comparing the 2009 H1N1 virus to Spanish flu [1:02:10]; Comparing SARS-CoV-2 to the Spanish flu [1:04:20]; What are John’s thoughts on how our government and leaders have handled the current pandemic? [1:08:00]; Sweden’s herd immunity approach, and understanding case mortality rate vs. infection mortality rate [1:10:40]; What are some important lessons that we can apply going forward? [1:13:00]; Does John think we will be better prepared for this in the future? [1:16:00]; and More Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/johnbarry Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:21:5517/04/2020
#106 - Amesh Adalja, M.D.: Comparing COVID-19 to past pandemics, preparing for the future, and reasons for optimism
In this episode, infectious disease and pandemic preparedness expert, Amesh Adalja, M.D., puts the current pandemic into context against previous coronaviruses as well as past influenza pandemics. Amesh also provides his interpretation of the evolving metrics which have contributed to big variations in modeling predictions, whether this will be a seasonally recurring virus, and perhaps most importantly—how we can be better prepared for the inevitable future novel virus. Finally, Amesh explains where he sees positive trends which give him reasons for optimism. We discuss: Amesh’s background in infectious disease [2:40]; When did the virus actually reach the US? And when did Amesh realize it would pose a real threat to the US? [4:00]; Comparing and contrasting COVID-19 to previous pandemics like the Asian flu of 1958 and the Spanish flu of 1918 [8:00]; Will COVID-19 be a recurring seasonal virus every year? [14:00]; Will a future vaccine be specific to this COVID-19 or will it also cover previous coronaviruses as well? [15:15]; What does Amesh think might be the true case fatality rate of SARS-CoV-2? [16:15]; Why did early models over predict infections and deaths by order of millions? [18:30]; Role of government—How does Amesh view the role of local versus central government in dealing with a future pandemic? [21:50]; What went wrong with testing and how could we have utilized it more effectively? [25:15]; Future pandemic preparedness—why Amesh is cautiously optimistic [27:30]; Should there be different policies and restrictions for places like New York City compared to less populated and less affected places across the US? [30:15]; Why mass gatherings might be disproportionately driving the spread of the virus [32:30]; Learning from HKU1, a lesser-known novel coronavirus from 2005 [34:00]; Thoughts on Sweden’s herd immunity approach [36:10]; The efficacy of masks being worn in public and what role they will play as restrictions are slowly lifted [37:20]; What are some positive trends and signs of optimism? [39:15]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ameshadalja Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
44:2413/04/2020
#105 - Paul Conti, M.D.: The psychological toll of a pandemic, and the societal problems it has highlighted
In this episode, psychiatrist Paul Conti, M.D. discusses the impact of the fear and uncertainty surrounding the COVID-19 pandemic and the resulting stress, anxiety, and trauma it may impart on the population. Paul examines how this situation has highlighted the challenges we face at the societal level as well as the individual level, and stresses the importance of seeking absolute truth above personal truth and taking action as individuals as a means to combat many of these pervasive problems. We discuss: Paul’s personal experience with a presumptive case of COVID-19 [2:15]; Through the lens of trauma, Paul’s overall take on the lasting effects of this pandemic on society [4:30]; The imperative to unite as a species given the isolating and suspicious nature of an invisible enemy [8:15]; The indigent population and the affluent population—The commonalities and differences in how both populations have been affected [16:15]; The prevailing feeling of demoralization spanning the population [25:30]; Health care workers—What lingering psychological effects might they suffer from this? [35:00]; Could this pandemic be a catalyst for changing the way people think about science, truth, and logic? [46:30]; How our inability to deal with uncertainty exacerbates the problem, and the need for humility [58:00]; What has been Paul’s recipe for self care during this time? [1:06:45]; The forthcoming challenge of reintegrating back into the world when the quarantines lift [1:14:45]; An urgent need for change which must come through individuals seeking absolute truth and taking action [1:19:15]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/paulconti2 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:26:4410/04/2020
#104 - COVID-19 for kids with Olivia Attia
In this episode, Peter sits down with his daughter to answer questions from her and other kids about COVID-19. We discuss: What is a virus? [1:45]; How did this version of coronavirus (SARS-CoV-2) start? [4:30]; How does COVID-19 compare to SARS and MERS (previous coronaviruses)? [6:00]; Will COVID-19 come back again after we resolve the current issue? [7:15]; When will kids go back to school? [7:45]; How has the US surpassed China in total cases, and how could we have been better prepared for this? [8:30]; Should have we started to quarantine sooner than we actually did? [11:45]; What about herd immunity? Would it be easier if we all just got the virus so we could be immune? [13:45]; Which age groups are the least and most at risk for getting a deadly version of the virus? [15:00]; Why do we have to wipe down packages that are delivered to our homes? [16:30]; How a lack of preparation and discipline led to this troubling situation [18:45]; Is China to blame for all of this? [24:15]; What did Olivia think when her parents pulled her out of school before it was mandated? [26:30]; What's been the hardest part of this for Olivia? [27:50]; What does Olivia appreciate now that she probably didn't appreciate in the past? [28:50]; How are Olivia’s zone 2 workouts going? [30:00]; and More Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/covid-19-for-kids Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
34:1608/04/2020
#103 - Looking back on the first 99 episodes: Strong Convictions, Loosely Held
In this episode, originally recorded to be the 100th episode of The Drive, Peter discusses topics that he has changed his mind about since starting the podcast as a result of preparing for interviews as well as from the actual conversations. Peter also reviews some of his favorite moments from the first 99 episodes, shares what books he’s currently reading, and much more. Initially scheduled to be released as episode 100, this was delayed due to recent podcasts covering COVID-19. We discuss: Definition of “strong convictions loosely held,” and the value in trying to shoot down your own hypotheses [2:20]; Metformin—How Peter’s strong convictions have changed since 2018 [8:00]; Getting a dog—Why Peter caved and how it’s going so far [15:45]; Rapamycin—How Peter’s feelings have evolved, and the questions still needing to be answered [20:45]; Archery, the joy of pursuing mastery, and the importance of stillness [26:50]; Zone 2 training—Why Peter has made it a big component of his exercise regimen [37:30]; Deadlifts—Why Peter now believes it’s extremely beneficial to longevity when done properly [41:45]; Read any good books lately? [50:00]; Baby aspirin for preventing blood clotting—Why Peter no longer takes it, and a few alternative options [53:15]; Generic drugs—How and why Peter’s mind has shifted on generic drugs [55:45]; Omega-3 fatty acids, EPA and DHA—How Peter’s long-held views have changed [58:15]; How Peter got better at saying “no” [1:02:30]; Does Peter have any favorite episodes of The Drive? [1:07:15]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/strong-convictions-loosely-held Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:17:2306/04/2020
#102 - Michael Osterholm, Ph.D.: COVID-19—Lessons learned, challenges ahead, and reasons for optimism and concern
In this episode, Michael Osterholm, Director of the Center for Infectious Disease Research and Policy at the University of Minnesota and author of Deadliest Enemy: Our War Against Killer Germs, provides an overview on the COVID-19 pandemic in regards to what has happened to date, what we’ve learned about how the disease spreads, and his optimism and pessimism about what potentially lies ahead. Michael gives his take on the true case fatality rate, why it differs around the world, and which underlying conditions, such as obesity, impact risk of severe illness and death. We also discuss the outlook regarding vaccines, repurposed drugs/antivirals for treatment, and Michael’s growing concern about supply chain limitations with respect to drugs, vaccines, n95 masks, and testing kits. We discuss: Recapping the brief history of COVID-19 and what potentially lies ahead [2:15]; Some positive news about immunity and reinfection [10:45]; Case fatality rate—The challenge in finding the true rate, difference by country, and the impact of age, underlying conditions, and obesity [13:00]; What has to be true for less than 100,000 Americans to die from COVID-19? [24:30]; How do we best protect healthcare workers? [29:45]; Concerns about testing capability—Reagent shortfall and a supply chain problem [39:30]; Vaccines and antivirals—The outlook, timing, and challenges [47:45]; Long term health of survivors of COVID-19 [56:45]; The impact of comorbidities—Diabetes, obesity, and immunosuppressed patients [59:30]; Understanding R0 and how the disease spreads [1:01:30]; The challenge of forecasting with so many unknown [1:08:00]; What explains the difference in cases and fatalities in different parts of the world? [1:14:30]; Repurposed drugs/antivirals being considered for treatment options—any optimism? [1:16:45]; A parting message from Michael about what lies ahead [1:18:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/michaelosterholm Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:22:2331/03/2020
#101 - Ryan Holiday: Finding stillness amidst chaos
Ryan Holiday, bestselling author and author of Daily Stoic, discusses practical ways to find stillness and apply the insights of stoic philosophy in the midst of COVID-19 chaos. Ryan discusses the importance of taking back a feeling of control, the benefits of structure and routine, and the idea of being prepared for anything. We discuss: Using times of adversity to evaluate and reflect how you’ve set up and prioritized your life [2:30]; What insights might the famous stoics provide amidst this COVID-19 pandemic? [8:15]; The possible consequences of the socially isolating nature of a pandemic (and why we need good leaders) [13:00]; Stoicism—what it means and how to apply it [18:45]; Lessons taken from the life of Winston Churchill—stillness, structure, routine, hobbies, empathy, forward thinking, and more [23:30]; Alive time vs. dead time—taking control of your time and making it count [38:45]; Auditing how the world (and its leaders) are handling the COVID-19 pandemic through the lens of stoic philosophy [44:15]; Asserting control and using routine to find stillness in an environment not conducive for it [52:15]; Why you should find a way to exercise, especially now [58:30]; How to find purpose during this time—goal setting, having a project to work on, and the benefits of keeping a journal [1:02:00]; What is Ryan most optimistic about and what is he most concerned about over the next few months? [1:08:45]; How can you follow Ryan’s work and messages about stoicism and stillness? [1:17:45]. And more. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ryanholiday2 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:22:4427/03/2020
#100 - Sam Harris, Ph.D.: COVID-19—Comprehending the crisis and managing our emotions
In this episode, Sam Harris, neuroscientist, author, and host of the Making Sense Podcast, joins Peter to discuss this unprecedented coronavirus (COVID-19) crisis. The discussion includes the important distinction between COVID-19 and influenza, the impact on the economy, the dire situation in New York, and the challenge of creating a safe and effective vaccine. Additionally, Sam brings insights from his extensive meditation practice to help those struggling with stress, anxiety, and fear in this extraordinary situation. We discuss: A time unlike any other—why many people don’t seem to fully grasp the magnitude of this situation [2:00]; Why comparing COVID-19 to influenza is a bad analogy [10:45] The impact on the economy of measures like shelter-in-place—Is the “cure” worse than the disease? [16:45]; Why are some places, like New York, getting hit so much worse? [24:45]; The trickle down effect of an overrun healthcare system on non-COVID-19 related health issues [34:45]; How to calm our minds and manage our emotions during this craziness [38:00]; Talking to kids about this situation without burdening them with undue stress [50:15]; Insights from meditation practice—Recognize and unhook yourself from a heightened emotional state [52:00]; How to make the most of a situation where you let your emotions get the best of you [59:15]; What are some potential positive things that Sam hopes could be learned from this crisis and applied to the future? [1:09:30]; The unfortunate politics being layered on top of this crisis [1:15:30]; The challenge of creating a safe and effective vaccine for COVID-19 [1:20:00]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/samharris2 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:32:2524/03/2020
#99 - Peter Hotez, M.D., Ph.D.: Continuing the conversation on COVID-19
In this episode, Dr. Peter Hotez M.D., Ph.D., Dean for the National School of Tropical Medicine Baylor College of Medicine, returns to continue the conversation on COVID-19. Dr. Hotez informs us on how we can gauge the number of infected people, behaviors to reduce the probability of becoming infected, and the inconsistency of hospitalizations among young adults between different countries. Dr. Hotez underscores the continued uncertainty in many virus-related developments, but ends with some points of optimism. Disclaimer: This is information accurate as of March 19, 2020, when it was recorded. We discuss: How to gauge true number of infected people [5:45] Reducing the probability of getting infected [22:45] Inconsistency by country in infected young people [27:15] Conferred immunity, seasonality, and repurposed therapeutics [30:30] Vaccine development [39:30] Practical behaviors to reduce risk of transmission [46:00] Mental Health resource and funding [51:00] Points of optimism [56:00]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/peterhotez-2 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:06:2120/03/2020
Qualy #129 - Evolutionary reasons to sleep
Today's episode of The Qualys is from podcast #47 – Matthew Walker, Ph.D., on sleep – Part I of III: Dangers of poor sleep, Alzheimer’s risk, mental health, memory consolidation, and more. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/ Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD
09:4217/03/2020
#97 - Peter Hotez, M.D., Ph.D.: COVID-19: transmissibility, vaccines, risk reduction, and treatment
In this episode, Dr. Peter Hotez M.D., Ph.D., Dean for the National School of Tropical Medicine Baylor College of Medicine, shares his expertise on viral disease and how it applies specifically to the coronavirus disease (COVID-19) and the virus that causes it (SARS-CoV-2). Dr. Hotez informs us about the current state of disease progression, which has many unknowns, but has thus far been greatly determined by the delayed response time and lack of testing. Moreover, we discuss what we can do on a country, state, community, and individual level in order to collectively slow transmission of the disease. He shares with us a potential hope in convalescent plasma therapy and underscores the need for US federal involvement - particularly in the creation of a specialty task force to address areas of concern and unknowns. Disclaimer: This is information accurate as of March 13, 2020, when it was recorded. We discuss: The disease and the virus: transmissibility and lethality [04:30]; Disease transmission: US playing catch-up [12:00]; Convalescent plasma coronavirus therapy [16:00]; Remdesivir drug treatment and vaccination challenges [19:45]; Disease mechanism and reported pathology [27:45]; Most concerning geographic regions in the US [39:00]; Risk reduction [46:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/peterhotez Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
57:0114/03/2020
Qualy #125 - Hierarchies in healthcare, physician burnout, and a broken system
Today's episode of The Qualys is from podcast #37 – Zubin Damania, M.D.: Revolutionizing healthcare one hilariously inspiring video at a time. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/ Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD
13:2510/03/2020
#96 - David Epstein: How a range of experience leads to better performance in a highly specialized world
In this episode, David Epstein, best-selling author of Range and The Sports Gene, discusses the evidence around the most effective ways to improve long-term performance and learning in our specialties, our sports, our careers, and our lives. David makes a compelling case that a range of experiences and skills are more likely to lead to expert performance compared to early specialization, and offers an in-depth critique of the much-publicized 10,000-Hour Rule. David also provides insights into our role as parents in the process of encouraging exposure to many things, the concepts of when to push them, when to give them space, and when to allow them to quit. Furthermore, David goes into many other fascinating topics such as the role of talent, genetics, and practice in reaching expert status, what differentiates a kind vs. wicked learning environment, the importance of “informal training,” and many case studies that suggest strategies for short-term success may not be best for long-term development. We discuss: A shared interest in Ayrton Senna, and pondering the value in participating in sports [2:30]; Examining the 10,000-Hour Rule, and the importance of questioning existing dogma [15:00]; How the medical profession is affected by bad science, and the importance of understanding individual variation [28:00]; David’s most surprising findings when writing The Sports Gene [35:45]; Kind versus wicked learning environments [40:45]; How and why strategies for short-term success may not be best for long-term development [47:30]; Contrasting the success stories of Tiger Woods and Roger Federer—which path is more common, and an argument for diversified training and experiences [59:15]; Is there an age-range or “critical window” during which exposure is necessary to reach a certain level of proficiency or mastery of a skill or knowledge? [1:14:00]; How diversifying your interests and unraveling your identity from your speciality could lead to more enjoyment and actually improve performance in your speciality [1:22:15]; The undervalued importance of “informal training” [1:29:15]; Advice for increasing match quality in your work—where interests and abilities align—to optimize both job performance and fulfillment [1:41:15]; Would David want his own son to attend college given the current state of higher education? [1:51:15]; The role of a parent—how to encourage sampling, when to push them, when to allow them to quit, and insights from the childhoods of Tiger Woods and Wolfgang Mozart [1:55:45]; The need for varied perspectives and the ability to improvise—insights gained from the Space Shuttle Challenger tragedy [2:08:45]; How a diversified background and identity could be the difference in life or death—the Hotshot firefighters case study [2:22:15]; David’s takeaways from the inspiring story of Frances Hesselbein [2:29:00]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/davidepstein Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
02:37:1009/03/2020
Qualy #121 - The “art” of longevity: the challenge of preventative medicine and understanding risk
Today's episode of The Qualys is from podcast #52 – Ethan Weiss, M.D.: A masterclass in cardiovascular disease and growth hormone – two topics that are surprising interrelated. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/ Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD
10:2703/03/2020
#95 - Luke Bennett, M.D.: The emotional, cognitive, and physical demands that make Formula 1 a unique and special sport
In this episode, Luke Bennett, Medical and Sports Performance Director for Hintsa Performance, explains the ins and outs of Formula 1 with a focus on the behind-the-scenes human element, and what makes it so emotionally, cognitively, and physically demanding for the drivers as well as the many team members. Luke first talks about his fascinating background with the Royal Flying Doctor Service in Australia, which lead to his current position with Hintsa working closely with F1 drivers to improve their health and performance despite jet-lag and sleep constraints due to an unrivaled travel schedule. Luke also sheds light on the underappreciated level of sheer physical strength and endurance it takes to drive an F1 car combined with the extreme cognitive aptitude, spatial awareness, and ability to navigate a socially complex environment that is needed to be successful as a driver. Additionally, Luke gives an overview of how the F1 season and races work, the incredible advances in car technology and safety measures, and what Luke and Hintsa hope to bring in the near future to the unique and special sport that is Formula 1. We discuss: What it’s like to be a “flying doctor” in Australia, and how Luke ended up working in Formula 1 with Hintsa [3:10]; Behind the scenes of Formula 1—crazy travel, jet lag, massive teams, and fascinating human storylines [10:45]; The incredible physical strength and cognitive aptitude needed to be a F1 driver [19:00]; The technological leap to hybrid electric engines [29:30]; The trend towards younger drivers in F1 [32:30]; Advancements in safety—the history and recent upgrades [36:00]; How Hintsa manages the athletes through the incredible social complexity of the sport [41:45]; Explaining the difference between F1, F2, F3, and F4, and the path to reaching the F1 [47:30]; Comparing F1 in the 60s & 70s to today—Incidences of deaths, number of crashes, physicality of driving, new regulations, and more [53:45]; Women in F1—Past, present, and future [1:06:10]; How F1 teams manage their cars and engine over the season, & some new regulations coming in 2021 [1:09:15]; What insights has Luke taken from his time as a triathlete to working with F1 drivers? [1:12:50]; How Luke survived cancer, and gained an increased sense of empathy [1:15:45]; How Luke manages his health against the brutal travel and lifestyle that comes with working in Formula 1 [1:19:40]; New training techniques, technology to monitor the physiology of drivers, and other things Luke is hoping to bring to Formula 1 [1:22:40]; How long does it take a driver to learn a new circuit? [1:27:45]; The incredible emotional control needed to be a successful F1 driver [1:30:00]; Which F1 teams are showing signs of competing in future seasons? [1:32:15]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/lukebennett Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:38:3102/03/2020
Qualy #120 - What is the difference between ketone salts and esters?
Today's episode of The Qualys is from podcast #05 – Dom D’Agostino, Ph.D.: ketosis, n=1, exogenous ketones, HBOT, seizures, and cancer. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/ Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD
06:2928/02/2020
#94 - Mark Hyman, M.D.: The impact of the food system on our health and the environment
In this episode, Mark Hyman, M.D., director of the Cleveland Clinic Center for Functional Medicine and the author of Food Fix, discusses that if we can fix the food system, we can solve many big problems—namely the chronic disease/obesity epidemic, the rising costs of healthcare, as well as the big problems facing the environment. Mark first briefly lays out the health consequences of processed food with a focus on the gut microbiome. From there, Mark discusses the environmental consequences of industrial farming and lays out how we can affect change on the individual level, through policy and regulations, and perhaps most importantly through regenerative agriculture. Additionally, Mark talks about the potential health risks of consuming GMO foods, herbicides, and other chemicals used in industrial farming as well as the environmental consequences, such as the loss of soil, caused by those same fertilizers and methods of farming. We discuss: The negative consequences of the existing food environment [3:25]; What makes processed food so unhealthy? [9:00]; The gut microbiome: Inflammation from gut permeability and how to measure gut health [18:30]; Steps to fixing a bad gut—The Five R’s [24:30]; Some staggering health statistics, and which races might be more genetically susceptible [27:15]; An argument for government regulations and policies to fight back against a massive food industry with unlimited resources (and what we can learn from the tobacco story) [29:00]; Industrial farming and climate change: The degradation of soil and use of fertilizer [41:45]; Regenerative agriculture: Could it be the answer to food waste, our health problems, and the environment? [51:45]; Comparing the Impossible Burger to regeneratively raised beef [1:06:00]; GMO and Roundup—The potential health risks of consuming GMO foods sprayed with Roundup (glyphosate) and other herbicides and pesticides [1:08:15]; How the livelihood of farmers are being affected by big ag companies and the current industrial farming system [1:16:30]; The loss of biodiversity in our food, and what “organic” really means [1:19:00]; What can people do on the individual level to protect themselves as well as affect change to the toxic food system? [1:25:00]; What role does the USDA play in this “toxic” food environment and how do we fix it? [1:30:15]; The top 3 changes Mark would make if he was “food czar” [1:35:15]; Mark’s rebuttal against the argument that it’s best for the environment if we stop farming animals and move to a fully plant-based diet (and his argument for “agriculture 2.0") [1:36:30]; What is Mark’s overall mission with the work that he’s doing? [1:40:30]; Bread in the US vs. Europe: Why does bread (and wheat products) taste different and potentially cause less health problems in Europe versus the US? [1:42:00]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/markhyman Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
01:50:2824/02/2020
Qualy #116 - Dealing with anger in spots where you know it’s coming
Today's episode of The Qualys is from podcast #34 – Sam Harris, Ph.D.: The transformative power of mindfulness. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/ Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD
08:4821/02/2020