In this episode, Tom Catena, a missionary physician who runs Mother of Mercy Hospital in the Nuba Mountains in Sudan, describes some of his extraordinary work as the only doctor in a remote, war-torn region of Africa. In terms of individual lives saved, you could argue that there is no other person on the front lines doing more than Tom. Additionally, we explore the manner in which the Nuba people die, which is in striking contrast the ubiquity of chronic disease and self-harm in the west, despite the extreme poverty and unimaginable suffering experienced by the Nuba people. Lastly, we discuss the lessons to be gleaned from the Nuba people, who despite their suffering, live so harmoniously, happily, and resiliently. To support Tom’s mission please visit www.amhf.us.

In this episode, Ted Schaeffer, Professor and Chair of the Department of Urology at Northwestern (youngest chairman in the country), presents the roadmap for the best way to screen for, and treat, prostate cancer. We also get into the “mass screening” controversy and all the risks involved with treatment. In addition, we discuss our evolving understanding of cancer and the most exciting areas of research to come. 

We discuss:

• Ted’s unique path to get his PhD [5:15];
• The exciting transition in science during Ted’s PhD in the 1990s [15:30];
• Ted’s advice to MD-PhD students, and why he choose urology and Johns Hopkins [23:45];
• History of prostate surgery, and Pat Walsh’s legendary work in prostate cancer [36:15];
• Prostate surgery and the risks involved with treatment [53:00];
• Screening for prostate cancer [58:00];
• The “mass screening” controversy [1:12:45];
• Biopsies and MRI: important things to know [1:25:30];
• Why urology such a great field of medicine, and why Peter wants a goat [1:34:45];
• Ted’s work with Ben Stiller [1:39:00];
• Gleason grading system [1:43:45];
• Testosterone, DHT and the prostate cancer controversy [1:53:15];
• The metabolism of the prostate [2:03:00];
• The most exciting areas of research in prostate cancer [2:08:00];
• Benign issues involving the prostate: pelvic pain, infections and treatments [2:11:15];
• Video of Ted’s surgeries, the latest technology, and males contraceptive options [2:18:00];
• Watches and cars [2:23:30]; and
• More.

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In this episode, Francisco Gonzalez-Lima, a Professor of Neuroscience and Pharmacology & Toxicology, explains the vascular hypothesis of Alzheimer’s disease which says the central problem is a progressive neuronal energy crisis of impaired blood flow to the brain and impaired mitochondrial respiration. He walks us through the ways we can intervene in this process and also shares details of the exciting future of Alzheimer’s treatment and prevention.

We discuss:

• Background and interest in the brain [5:15];
• The unique nature of the human brain [9:15];
• Why we’ve made so little progress in Alzheimer’s research [23:00];
• The amyloid beta hypothesis [28:30];
• Hypometabolism in the brain leading to cognitive decline [39:30];
• Early signs of AD, and deciphering between age-related decline versus something pathologic [47:45];
• The vascular hypothesis of Alzheimer’s disease [54:00];
• The relationship between mitochondria, cytochrome c oxidase, and Alzheimer’s disease [1:08:00];
• Chronic inhibition of cytochrome c oxidase leads to chronic neurodegenerative disease [1:22:45];
• Major risk factors for AD, head trauma, and other forms of dementia [1:33:45];
• Methylene blue for treating and preventing neurodegeneration [1:38:15];
• Current standard of care for AD, and the reasons for a lack of advancement [2:01:45];
• Near infrared light as a targeted treatment for cognitive decline [2:05:30];
• The ketogenic diet as a treatment and preventative measure [2:13:15];
• Exciting future research coming from Francisco [2:13:00];
• Methylene blue for traumatic brain injuries [2:25:15]; and
• More.

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In this episode, Zubin Damania, a.k.a. Zdogg MD, a Stanford trained physician and founder of Turntable Health, discusses his evolution from disillusioned doctor suffering burnout to leading the charge for a radical shift in how we practice medicine. We also go down the rabbit hole on all sorts of juicy topics from meditation to nutrition to the nature of consciousness itself.

In this episode, Dr. Eric Chehab, orthopedic surgeon and sports medicine specialist, explains the measures we can take to live better and maintain our physical health through exercise and the avoidance of common injuries that prove to be the downfall for many. He also provides valuable insight for those weighing their treatment options from physical therapy to surgery to stem cells. 

 We discuss:

• Favorite bands, musicians, and concerts [3:30];
• Eric’s upbringing, biggest influences, college life, and teaching overseas [12:45];
• Eric’s training, fellowship with the New York Giants, and the risk vs. reward of playing football [39:15];
• The knee joint: common injuries, knee replacements, and proper exercise [1:00:00];
• Best exercise for orthopedic health and bone density [1:10:00];
• Most common injuries: knee, hip, shoulder, elbow, ankle, foot [1:20:45];
• Physical therapy vs. surgery, and the meniscus surgery controversy [1:28:30];
• PRP, stem cells, sham surgeries, and the placebo effect [1:41:00];
• Back injuries: when does surgery make sense? [1:54:15];
• How to find the right orthopedic surgeon for you [2:01:45];
• How to cope with complications and maintain quality of life through adaptation [2:09:15];
• Dr. Bukk Teef [2:26:45]; and
• More.

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In this episode, Nir Barzilai, director of the Institute for Aging Research and expert in the genetics of longevity, discusses the evidence that metformin and rapamycin have anti-aging properties and how his TAME study aims to support this hypothesis in humans. Additionally, he describes the role of genetics in lifespan/healthspan and how it might affect important pathways such as IGF and insulin sensitivity.

We discuss:

• Nir’s background and interest in aging and endocrinology [3:30];
• History of metformin, and understanding the mechanism [11:15];
• Attempting to define insulin resistance [21:15];
• Metformin as a possible anti-aging drug [48:45];
• The TAME trial: Targeting Aging with MEtformin [57:45];
• Why Nir believes metformin can slow aging [1:16:30];
• The genetic gift of centenarians [1:28:00];
• IGF/GH and its impact on aging and chronic diseases [1:34:15];
• Genetics/epigenetics of centenarians, gene sequencing, CETP-VV, Lp(a) [1:49:15];
• Should you be taking HGH? [2:05:30];
• NAD and NAD precursors (NR and NMN) [2:30:00];
• Parting thoughts on metformin [2:36:15];
• Possible blind spots in Nir and Peter’s thinking? [2:43:00]; and
• More.

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In this episode, Sam Harris, neuroscientist, author, and host of the Waking Up Podcast, walks us through the profound, yet practical, ways that meditation can transform our lives. Additionally, he helps to define the types of meditation and clarifies potential misconceptions with terms like happiness, pain, and suffering.

We discuss:

• The transformative moment that led to Peter reaching out to Sam [3:45];
• Comparing the two broad types of meditation, and Peter’s favorite meditation apps [7:45];
• The pleasure of a concentrated mind, meditating with pain, and the difference between pain and suffering [13:15];
• What it means to be happy, and how to break out of our default state [23:15];
• The disease of distraction, why humans suffer, the limitation of happiness, and letting go of anger with mindfulness [31:00];
• The challenge of learning mindfulness, the benefit of silent retreats, and Sam’s first experience in solitude as a teenager [54:15];
• Sam’s life-altering experience with MDMA [1:03:00];
• Mettā meditation a.k.a. loving-kindness, and the concept of ‘moral luck’ [1:14:00];
• Overcoming grief and dread with meditation [1:34:45];
• The wrong way to practice mindfulness, and the difference between Vipassana and Dzogchen [1:44:45];
• Sam’s commitment to never lie, honesty in politics, and Sam’s viewpoint on the Trump phenomenon [2:06:00];
• Teaching kids to be more mindful [2:18:30];
• Sam’s current book projects, the consequences of a politically correct environment, and the potential of neuroscience to cure psychopathy [2:25:30];
• How you can follow Sam’s work [2:39:00]; and
• More.

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In this episode, Dr. Rudy Leibel, an expert in Clinical Molecular Genetics and Genomics at Columbia University, discusses his role in the remarkable scientific story of discovering leptin. He also gets into the genetics of obesity, as well as a broader discussion of the causes and effects of obesity, energy expenditure, and metabolism.

We discuss:

• Rudy’s background, interest in obesity, and trying to understand the role and impact of adipose tissue [4:15];
• Finding the first evidence of leptin by studying obese mice [23:30];
• Zucker rats, and the push/pull theories of obesity [34:45];
• A breakthrough in obesity research, and closing in on leptin [45:45];
• Understanding leptin in humans [1:03:30];
• What Prader–Willi syndrome teaches us about body weight regulation [1:09:45];
• Leptin and the broad condition of obesity, metabolic consequences of weight reduction, and Peter’s self-experiments [1:18:00];
• How is appetite being regulated? [1:29:45];
• Are there epigenetic consequences of being obese? [1:37:00];
• What makes low-carb diets so effective at obesity reduction? [1:51:00];
• What did Rudy believe 10 years ago that he no longer believes to be true? [2:00:00];
• Rudy’s dream study of the FTO gene [2:02:30];
• What the hell does insulin resistance actually mean? [2:13:15]; and
• More.

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In this episode, Siddhartha Mukherjee, oncologist, researcher, and author of the Pulitzer Prize-winning book “The Emperor of All Maladies: A Biography of Cancer,” discusses his writing process, his thoughts about medicine, cancer, immunotherapy, and his recent collaboration on a study combining a ketogenic diet with a drug in mice that provided remarkable and encouraging results.

We discuss:

• Sid’s background [5:00];
• How Sid and Peter met [6:00];
• Sid’s Pulitzer Prize-winning book: The Emperor of All Maladies [8:00];
• Sid’s writing process: the tenets of writing [12:30];
• Our struggle to find preventable, human, chemical carcinogens of substantial impact [23:30];
• The three laws of medicine — Law #1: A strong intuition is much more powerful than a weak test [26:30];
• Law #2 of medicine: “Normals” teach us rules; “outliers” teach us laws [32:00];
• Law #3 of medicine: For every perfect medical experiment, there is a perfect human bias [35:00];
• The excitement around immunotherapy [38:15];
• The story of Gleevec [46:00];
• How does the body's metabolic state affect cancer? [49:30];
• Can a nutritional state be exploited and/or a drug sensitivity be exploited through a nutritional intervention? [52:00];
• How does Sid balance his family, writing, research, laboratory, and patients? [1:00:30]; and
• More.

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In this episode, Nav Chandel, a professor of medicine and cell and molecular biology at Northwestern University, discusses the role of mitochondria and metabolism in health and disease. Nav also provides insights into the mitochondria as signaling organelles, antioxidants, and metformin’s multifaceted effects on human health, among many topics related to well-being.

We discuss:

• What got Nav interested in mitochondria [5:00];
• Reactive oxygen species (ROS) [16:00];
• Antioxidants: helpful or harmful? [20:00];
• Mitochondria as signaling organelles [22:00];
• Hydrogen peroxide (H2O2) [25:00];
• Mitochondrial DNA [28:00];
• Mitochondria and aging [45:00];
• Metformin [52:45];
• Metformin and the gut microbiome [54:00];
• Metformin as complex I inhibitor and the importance of the NADH/NAD ratio [1:01:00];
• Anticancer benefits of metformin [1:07:45];
• Mitochondrial function is necessary for tumorigenesis [1:15:00];
• Are somatic mutations the result of mitochondrial dysfunction? [1:31:30];
• Vitamins and antioxidants [1:37:00];
• Targeting inflammation in disease [1:43:00];
• NAD precursors [1:45:45];
• MitoQ [1:52:00];
• Metabolite toxicity [1:56:30];
• Cortisol and healthy aging [2:02:00];
• Nav turns the tables and asks Peter how he deals with the “So what should I eat?” question during social encounters [2:09:00]; and
• More.

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In this episode, Thomas Seyfried, a cancer researcher and professor of biology at Boston College, discusses a controversial view of cancer as a mitochondrial metabolic disease. Many topics related to the causes, treatments, and prevention of cancer are covered in this in-depth conversation.

We discuss:

• How Tom got interested in cancer research [9:00];
• Calorie-restricted ketogenic diets, fasting, and epileptic seizures [18:30];
• Otto Warburg and the Warburg effect [30:45];
• Germline mutations, somatic mutations, and no mutations [42:00];
• Mitochondrial substrate level phosphorylation: Warburg’s missing link [51:30];
• What is the structural defect in the mitochondria in cancer? [1:02:00];
• Peter’s near-death experience with the insulin suppression test while in ketosis [1:06:30];
• Insulin potentiation therapy and glutamine inhibition [1:13:15];
• The macrophage fusion-hybrid theory of metastasis [1:39:30];
• How are cancer cells growth dysregulated without a mutation? [1:47:00];
• What is the dream clinical trial to test the hypothesis that we can reduce the death rates of cancer by 50%? [2:03:15];
• How can the hypothesis be tested rigorously that structural abnormalities in the mitochondria impair respiration and lead to compensatory fermentation? [2:26:30];
• Case studies of GBM survivors [2:32:45]; and
• More.

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In this episode, 8-time Olympic medalist, Apolo Ohno, discusses the lessons he’s learned from his remarkable career in speed skating and the extreme physical and mental training — and determination — required to reach greatness.

We discuss:

• Apolo’s childhood with his single dad, early success in sports, and falling in love with skating [7:30];
• The differences between inline and ice skating, and short- & long-track speed-skating, and the evolution of the clap skate [21:00];
• The mental game and the physical game: intense training and mindset [29:30];
• Apolo’s early success in short-track that led to an amazing opportunity and his reluctance to go for it [40:15];
• Early days at Lake Placid, first experience on the world stage, and a little self-sabotage [56:45];
• Tough love parenting, making a commitment, training like Rocky, and developing the mindset of a fighter [1:17:30];
• 2002 Olympics, winning his first medal, and rising above the sport [1:32:45];
• Apolo’s evolving training and body composition throughout his Olympic career [2:05:15];
• Going into the Lion’s Den to learn from Korean skaters and making a radical and risky change that led to his most successful Olympic games [2:12:45];
• Apolo’s tumultuous relationship with South Korea, from hatred to respect to admiration [2:29:00];
• Applying lessons learned through training, adjusting to life after skating, and the struggles many athletes face transitioning to retirement [2:46:30];
• The final years of Apolo’s career: intense focus, crazy training, mental fortitude, and resiliency [2:57:30];
• Officially retiring and contemplating a comeback [3:16:15];
• Where does Apolo want to be in 10 years? [3:22:45];
• The pursuit of perfection and flow states [3:29:30];
• Where you can follow Apolo [3:35:00]; and
• More.

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In this episode, Mark and Chris Bell discuss their love of powerlifting, their unbelievable personal records, and what prompted the making of their now iconic film, Bigger, Stronger, Faster. They also very openly discuss steroid use, their tragic family history with addiction, the many inspirations that lead to their multifaceted success, and their dedication to having a positive impact on others in fitness and life.

We discuss:

• The impact of Bigger, Stronger, Faster, how it got made, and how it challenged Peter’s set of beliefs regarding steroids [4:45];
• Chris’s personal story of addiction and how he’s using his experience to help others [17:30];
• Importance of sharing your struggle, and the danger of comparing yourself to others [28:00];
• Early life, their love of pro wrestling and what motivated Brothers Bell to be great? [33:45];
• How they got started lifting weights, powerlifting vs Olympic lifting, and personal records [43:30];
• Lifting weights: the importance of challenging yourself, how to avoid injury, monitoring progress, and staying motivated [1:02:30];
• Chris on how changing his diet changed his performance and life [1:09:15];
• Best resources for those wanting to get started lifting weights effectively and safely [1:14:00];
• Teaching kids strength training early in life, the negative impact of sitting and how we can minimize it [1:18:30];
• Benefits of bodybuilding, Mark’s prep for his first competition, and the role of the ketogenic diet [1:27:15];
• The steroid controversy: Mark’s use of them and Peter’s perspective [1:42:15];
• Testosterone: Peter’s approach to improving it in patients, and the impact of sleep, cortisol, and statins on production [1:51:00];
• Upcoming nutrition documentary [2:03:00];
• Parting advice from Mark [2:05:00];
• Kratom, a powerful plant with the potential to help opioid addiction and more [2:06:15];
• The many resources and ways to follow Mark and Chris [2:07:45]; and
• More.

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In this episode, David A. Sinclair, Ph.D., a Professor in the Department of Genetics at Harvard Medical School and co-Director of the Paul F. Glenn Center for the Biological Mechanisms of Aging, provides insight into why we age and how to slow its effects based on his remarkable work on the role of sirtuins and NAD in health and diseases. He also presents the case that stabilizing the epigenetic landscape may be the linchpin in counteracting aging and disease. 

We discuss:

• How and why David moved from Australia to Leonard Guarente’s lab at MIT [7:30];
• Sirtuins and aging [15:00];
• A series of experiments elucidating the mechanisms of sirtuins [20:45];
• How are sirtuins activated? [25:30];
• NAD and sirtuin activation [31:00];
• Nicotinamide, sirtuin inhibition, andPNC1 [39:00];
• Resveratrol [43:00];
• The NIH/ITP studies on resveratrol [55:45];
• Does David take any compounds for longevity? [1:00:15];
• NAD precursors (NR, NMN) and pterostilbene [1:02:45];
• Female fertility and NAD precursors [1:14:45];
• A unifying theory of aging [1:20:30];
• Waddington’s epigenetic landscape [1:23:00];
• If David had unlimited resources, what is the experiment he would do? [1:28:25];
• Testing combinations to extend lifespan [1:31:30];
• What made David aware of his mortality at such a young age? [01:33:45];
• What is David’s book going to cover? [01:37:15]; and
• More.

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In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter’s head analyst, asks the questions.

This also marks the first video release of the podcast. You can find it on YouTube (https://youtu.be/kzs7GgxR_FQ) and the website (peterattiamd.com/ama03).

If you have any questions for the next AMA, please submit them to the AMA section on the website (peterattiamd.com).

We discuss:

• What references ranges does Peter consider too broad on lab tests? [5:30];
• What aspect of women’s health is the least studied/understood? [21:15];
• What are your thoughts on fasting and ketosis for females? [31:30];
• Advice for medical students and residents, how to get through it, and optimize their time while in med school [38:00];
• What is Peter’s opinion on the best way to monetize a podcast to make it sustainable? [47:45];
• What are you looking to achieve and monitor with your blood glucose monitor? [57:15];
• Thoughts on lithium supplementation? [1:08:15];
• Insights about berberine? [1:16:00];
• Why does Peter take a baby aspirin? What does the science say? [1:19:20];
• How do you use HR variability as a metric in your practice and/or in your own personal use? Sleep, pre/post exercise, pre/post eating, every morning readiness? [1:23:25];
• With the emergence of “the coconut oil is pure poison” article, can you shed some light on saturated fat in the literature and the types of studies done specifically on coconut oil? [1:38:45];
• Would you discuss the recent meta studies that claim that moderate carbohydrate intake may be best for health? [1:40:45];
• What is the number one recommendation/habit you would suggest every person add to their daily regimen (besides physical activity) for wholesome health? [1:42:45];
• What does it mean if your body has a harder time getting into ketosis via fasting than it used to (testing using a Precision Xtra)? [1:44:15];
• Why are you taking Zetia and Lipitor? Are you mitigating risk based on your APOE4? Or is there something else going on? [1:46:10];
• What will your book be about and what is the expected release date? [1:47:45];
• What are your thoughts on nicotinamide riboside supplementation for longevity? [1:49:30];
• Which brand of supplements have you found to be effective? [1:54:30];
• Are you currently accepting new patients? And how do I find a ‘Peter Attia clone’ in my area? [1:56:20];
• Bob’s personal experience with Peter as a doctor [1:58:45];
• Can you tell us more about the latest and best of APOE4? [2:06:15]; and
• More.

Learn more at www.PeterAttiaMD.com

We discuss:

• How Scott and Peter met [3:45];
• Scott’s tragic family story that shaped his life and altered his trajectory [8:00];
• High school years, rebellion, and music [30:30];
• Life as a club promoter, drug use, soul-searching, and a change of heart [41:30];
• Mercy Ships [1:15:00];
• The amazing transformations of Mercy Ships and the parallels to his own transformation [1:28:00];
• Leveraging the art of storytelling to raise money and awareness while fighting temptations to fall into his previous life [1:33:30];
• Discovering the water crisis that lead to charity: water [1:46:45];
• How the lack of trust in nonprofits can cripple charities [1:54:00];
• The four pillars of charity: water that helped it overcome the stigma of nonprofits and become successful [2:01:00];
• Where to learn more about Scott’s work and charity: water [2:12:30];
• Scott’s book recommendations [2:14:30]; and
• More.

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In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. In Part V, Peter and Tom talk about inflammation, endothelial health, and oxidative stress as they pertain to cardiovascular disease, and our attempts to monitor them using biomarkers. They also discuss a couple of very important risk factors that too few people (and doctors) know about. Tom closes the five-part series with a tragic story about his good friend that is likely all-too-common for many practicing physicians, that both haunts and motivates Dr. Dayspring to learn as much as he can about the number one killer in the United States.

We discuss:

•     Lp(a) [2:30];
•     Inflammation [17:15];
•     Oxidative stress markers: Lp-PLA2 and oxLDL [20:45];
•     Endothelial health markers: ADMA and SDMA [34:30];
•     Remnants [43:45];
•     Omega-3 fatty acids (EPA and DHA) and apoC-III [55:30];
•     Red blood cells and cholesterol transport [1:07:45];
•     Tom's friend Earl [1:10:00];
•     Peter's friend JP [1:18:15]; and
•     More.

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In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. In Part IV, Peter and Tom review the history and current use of drugs to prevent cardiovascular disease. They also discuss why some drugs appear to be more effective than others, an in-depth conversation about niacin, cholesterol and brain health, and the futility of using CKs (creatinine kinase) and liver function tests to identify adverse effects in statins, to name a few topics in this episode.

We discuss:

• Bile acid sequestrants and statins [2:00];
• Ezetimibe (Zetia) [15:00];
• PCSK9 inhibitors [27:30];
• Fibrates [41:00];
• Fish oil, DHA, and EPA [1:01:00];
• Niacin [1:05:15];
• PCSK9 inhibitors [1:23:45];
• Cholesterol, statins, and the brain [1:30:00];
• Elevated creatine kinase (CK) and liver function tests (LFTs) on statins [1:50:30]; and
• More.

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In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. In Part III, Peter and Tom dig into HDL, why "reverse cholesterol transport" is a lot more nuanced than what most of us are taught, lipid transport, apolipoproteins, and more. In addition, this episode highlights the complexity of HDL and a discussion about the CETP inhibitor trials.

We discuss:

• Reverse cholesterol transport [1:40];
• Lipid transportation, apolipoproteins, VLDL, IDL, and LDL particles [11:00];
• Remnant lipoproteins and apoC-III [16:45];
• Particles having sex: lipid exchange [28:00];
• Cholesteryl Ester Transfer Protein (CETP) and CETP inhibitors [40:45];
• 2006 CETP inhibitor trial: torcetrapib (Pfizer) [54:45];
• 2012 CETP inhibitor trial: dalcetrapib (Hoffmann–La Roche) [56:15];
• 2017 CETP inhibitor trials: evacetrapib (Eli Lilly) and anacetrapib (Merck) [58:00]; and
• More.

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In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. Part I serves as an introduction to Tom, his work, and an overview of lipid terminology.

We discuss:

• Tom’s recent and remarkable physical transformation [6:30];
• The moving stories behind Tom’s obsessions: firefighting, hockey, and, of course, lipids [20:30];
• Tom’s medical background [39:30];
• Producing some of the most accessible diagrams on lipids [50:00];
• What are the different kinds of lipids, what do they do, and how are they transported? [57:15]; and
• More.

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In this episode, Dave Feldman, discusses his journey from software engineer to n=1 experimenter, his experience with low-carbohydrate diets, and his hypothesis that cholesterol levels are influenced by energy metabolism.

We discuss:

• Peter’s synthesis of Dave’s energy model [5:00];
• Dave’s journey from software engineer to cholesterol enthusiast [15:00];
• Standard blood panels, sterol panels, and what moves the needle when it comes to particle numbers [18:30];
• Hyper-responders [20:00];
• Lipoprotein transport [33:45];
• The lean mass hyper-responder phenotype [47:30];
• The progression of atherosclerosis, CAC, and CIMT [52:30];
• Testing for oxidized LDL [55:30];
• All-cause mortality and clinical endpoints [1:01:15];
• What does “LDL as causal” mean? [1:05:15];
• Dave’s low carb cholesterol challenge and drug & genetic study qualifications [1:13:15];
• If all other markers are in an healthy range, but LDL-P is high, is the patient at risk? A couple of case studies, and a self-experiment [1:27:30];
• Peter’s three-day exercise and ketosis experiment [1:41:00];
• What are remnant lipoproteins? [1:45:00];
• What might cause lean mass hyper-responders to have higher LDL particle numbers? [1:53:30];
• A case study from Dave of a lean mass hyper-responder [1:56:30];
• Mass balance and cholesterol flux [2:05:30];
• Can a higher degree of cholesterol explain the lean mass hyper-responder phenotype? [2:10:00];
• Peter’s LDL during his keto-fast-keto experiment [2:13:30];
• Does substituting saturated fats with monounsaturated fats lower LDL-P and LDL-C? [2:15:45];
• Dave’s carb-swap experiments [2:22:15];
• Dave’s carotid intima-media thickness tests [2:41:15];
• Looking for studies that stratify for high HDL-C and low TG alongside low and high LDL-C [2:53:00]; and
• More

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In this episode, Richard Isaacson, a neurologist and director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine and NewYork-Presbyterian, discusses strategies for staving off Alzheimer’s disease. Richard shares a wealth of insight for people who want to know more about Alzheimer’s and what you can do to help yourself and your loved ones – starting today and continuing throughout the entire lifespan.

We discuss:

• Richard’s fun-facts (and alter egos): “bling” phones, Doogie Howser, and DJ Rush [8:00];
• Richard’s impetus to focus on Alzheimer’s disease: Uncle Bob [18:20];
• Starting an Alzheimer’s Prevention Clinic [27:00];
• How Alzheimer’s is diagnosed [30:00];
• Short-term memory, processing speed, executive function and how they’re tested [35:45];
• Prevention vs reduction of Alzheimer’s [44:00];
• What is the prevalence of Alzheimer’s in America? [49:30];
• How do people actually die from Alzheimer’s or dementia? [51:30];
• How can people do everything right and still get Alzheimer’s? It’s all about AGE [55:15];
• The APOE gene [58:15];
• Why is the risk of Alzheimer’s higher for women? [1:13:00];
• How many different paths lead to Alzheimer’s? [1:15:45];
• What role does MTHFR play in Alzheimer’s? [1:19:45];
• What are the “ABCs” of Alzheimer’s prevention? [1:26:45];
• Baptists, Tauists, Syners, and Apostates [1:36:30];
• Concerns with statin use for high-risk patients [1:45:00];
• The use of Theracurmin [1:48:45];
• What are the five actionable things one can do to reduce the risk for Alzheimer’s today? [1:54:30];
• The cognitive reserve [2:14:15]; and
• More.

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In this episode, ultra-endurance athlete and entrepreneur, Mike Trevino, discusses the lessons he’s learned from his remarkable athletic feats, and the training required to reach them. Not only is Mike’s advice practical for those looking to take their endurance training to the next level, but his lessons and insight are extraordinarily applicable to living everyday life.

We discuss:

• Mike’s background, his crazy birthday tradition, and his transition from power to endurance [6:30];
• Mike’s breakthrough year: setting a course record, and completing the Badwater 135 [16:00];
• Race Across America (RAAM), perseverance, and extreme sleep deprivation [25:30];
• Mindset, nutrition, fasting, and other advice from Mike for those looking to take the next step in their training [49:00];
• What getting a parasite taught Mike about fasting [59:45];
• The risks involved with cycling [1:03:00];
• Mike setting the trans-Iowa (RAGBRAI) record [1:10:15];
• PEDs, stimulants, and their effect on performance [1:15:00];
• What motivates Mike (and others) to do this extreme stuff? What led him to eventually pull back? [1:22:00];
• Life-lessons learned from training, and how to impart them to his kids, and others [1:35:30];
• The greatest beer in the world remains a mystery [1:46:15]; and
• More.

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In this bonus episode, Peter and med school colleague (and brilliant psychiatrist) Paul Conti reminisce on their favorite moments in Formula 1 history, their deep admiration for the late Ayrton Senna, and the remarkable careers of their all-time favorite drivers. Paul also helps to illuminate the psychological components that made the luminary drivers great, and the cautionary lessons we can take from their incredible lives.

We discuss:

• Ayrton Senna [3:45];
• How Senna’s death changed the sport [9:50];
• The 80s & 90s: a remarkable era of Formula 1 [12:55];
• Hypothesizing what caused Senna’s fatal crash [17:45];
• Comparing Stewart and Senna, their incredible bravery, and what lessons we can learn from them [23:30];
• Best documentaries on racing, and some of Senna’s best moments [31:00];
• Gilles Villeneuve, Stefan Bellof, and some of the other greats [39:15];
• Why Senna is widely acknowledged as the best of all time [46:15];
• Great rivalries and personalities [49:30];
• Rendezvous, a high-speed drive through Paris [56:50]; and
• More.

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In this episode, psychiatrist Paul Conti, M.D. discusses the impact of untreated trauma, the rising rate of suicide, and the influence of modern society on mental health, to name a few important topics covered. Paul also talks about how to deal with these challenges for yourself, your loved ones, and the community at large.

We discuss:

• Paul’s background, and what drove him to psychiatry [5:00];
• How silent bravado and incessant striving can lead to a functional (and actual) death, and why Paul is critical of the current state of psychiatry [14:45];
• Psychedelics, psychotherapy and the dissolution of the ego [20:30];
• How current society may be contributing to the increasing amount of suffering [25:00];
• The ubiquity and impact of untreated trauma [31:45];
• The rising rate of suicide, parasuicide, and “accidental” death [35:30];
• Types of trauma, why we minimize it, and Peter’s introduction to Bridge to Recovery [44:00];
• Triggering shame and fear, childhood trauma, and why trauma doesn’t care about time [48:00];
• The impact of the brain on the body, and overcoming trauma with self-awareness [55:00];
• How to recognize and stop the cycle of shame transference [1:04:30];
• Peter’s profound experience at Bridge to Recovery, and the importance of finding shared experiences with others [1:11:15];
• How to identify and deal with our own personal trauma [1:19:00];
• Finding meaning in struggle, why we are less happy than ever, and the impact of an isolated society [1:25:30];
• What steps can we take as a society to make an appreciable impact on the rising sense of desperation and misery? [1:43:15];
• Resources, book recommendations, and things you can do [1:56:15]; and
• More.

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In this episode, Rob Lustig — a researcher, an expert in fructose metabolism, and a former pediatric endocrinologist — discusses what’s wrong with the current food environment, and what we can do to reduce our chances of becoming part of the obesity, diabetes, metabolic syndrome, and nonalcoholic fatty liver disease (NAFLD) epidemics. Rob recently earned a Master of Studies in Law because he believes that educating people about sugar from a scientific standpoint is only half the equation: the other half involves changing policy, which he explains in this episode.

We discuss:

• What’s the difference between glucose and fructose? [7:00];
• Do we have biomarkers that can give us some indication of average exposure to fructose over a given period of time? [14:20];
• What’s the difference between ALT and AST? [18:45];
• Inflammation, endothelial function, and uric acid [21:30];
• Is there something that fructose does better than glucose? [23:45];
• For children that undergo a remarkable shift from metabolic health to metabolic derangement, is there a concern that these kids suffer an epigenetic hit that makes it harder for them later in life? [26:15];
• How many times do you have to introduce a savory food vs a sugary food to an infant before they will accept it? [29:30];
• How are alcohol and fructose similar in how they affect the brain? [33:51];
• Advice for parents and kids for creating a sustainable environment that's going to prevent them from running into metabolic problems [40:30];
• Why do some populations have a higher risk for NAFLD? [45:42];
• What causes NAFLD? [48:45];
• Is insulin resistance the result of NAFLD or is NAFLD the result of insulin resistance? [56:00];
• HRV, cortisol, and norepinephrine [1:00:30];
• What are the actual mechanisms that links metabolic syndrome, insulin resistance, fatty liver, and type 2 diabetes? [1:03:00];
• Is the food industry still saying that all calories contribute equally to adiposity and insulin resistance? [1:09:00];
• What is the difference between soluble and insoluble fiber and why do you need both? [1:13:00];
• How can we change the food system when 10 companies control almost 90 percent of the Calories we consume in the US? [1:15:00]; and
• More.

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This episode explores the question of how we can maintain a naturally youthful look as we get older. Brett — a New York City oculofacial plastic surgeon who specializes in both non-surgical and surgical cosmetic and reconstructive procedures of the eyes and face — shares some remarkably practical advice on everything from the most extensive procedural options, down to the simple steps one can do themselves, starting today, that can make a tremendous impact. Brett also discusses how to pick a provider you trust while you’re sorting through the ever-growing list of facial treatments and cosmetic procedures.

We discuss:

• History of medical training that led to Brett’s current interests [5:00];
• What changes occur that make skin look older over time? [8:00];
• How to avoid the “unnatural” look associated with cosmetic surgery [17:00];
• Facial augmentation, fixing eye-bags, and picking the right provider [22:15];
• Common botox mistakes, and how to do it right [37:30];
• Protect and rejuvenate your skin with these 3 main tools [46:30];
• Latest trends in cosmetic industry, botox, cryolipolysis, the various forms of facials, and PRP [1:05:00];
• Importance of picking a provider you trust, rather than a device you want [1:31:30];
• Future of the cosmetic field [1:33:00]; and
• More.

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Corey and Peter met when they visited North Kern State Prison in California together as volunteers for Defy Ventures. Peter was moved by Corey’s remarkable story, who is a former inmate himself, and realized he had to have him on the podcast to share his experiences with a wider audience. You’ll almost assuredly take away something very important from listening to this episode. Understanding how your experiences can define you, what forgiveness means of both yourself and others, and how good people can do bad things, are just a few of the takeaways.

We discuss:

• How Corey and Peter met through Defy Ventures [4:00];
• How Corey’s prison experience has shaped his life story [13:30];
• Corey’s early life, and the traumatic event that changed everything [16:00];
• Early adolescence years, beginnings of addiction, and overwhelming shame [23:00];
• The 5 ways to classify wounds, and the relationship between trauma and addiction [39:00];
• Turbulent high school years, the struggle of parenting a troubled child, and more trauma further shaping the self-narrative [46:00];
• Post high school years, spiraling out of control, and giving up on himself [1:02:00];
• Navigating prison life, and why a desire to change often isn’t enough to make it happen  [1:19:00];
• The turning point and eventual road to recovery [1:48:00];
• 12 step programs: Pros and Cons [1:54:00];
• Final days in prison, getting released, and routines Corey has kept [1:54:00]
• Corey’s new perspective on life, takeaways from the visit to Kern prison [2:12:30]; and
• More.

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Consider this episode a cross between an ask me anything (AMA) and a show-and-tell. Peter discusses his fasting experiment in great detail and answers questions from listeners and readers.

We discuss:

• Why Peter did a one-week fast and the rationale for front- and back-ending it with a week-long ketogenic diet [6:30];
• What Peter’s typical diet, exercise, sleep, stress management, and supplementation looks like [11:00];
• What labs (e.g., glucose, ketones, lipids, inflammation and oxidation markers, thyroid- and sex hormones) Peter checked for the experiment [22:00];
• Peter’s results after a week on a ketogenic diet [29:30];
• Peter’s results after a week on a water-only fast [48:45];
• Peter’s results after a week on a ketogenic diet following a week of fasting [58:30];
• Peter’s “Top 6” surprises from the fasting experiment [1:08:30];
• Different fasting-mimicking diet (FMD) protocols [1:29:20];
• What is the optimal protocol, frequency, and duration for fasting? [1:33:00];
• How to break a fast without GI distress? [1:38:00];
• “Am I breaking the fast if…?” [1:41:30]; and
• More.

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Matt is someone who is deeply interested in understanding the biology of aging. Why do we age? What happens to us as we age? What are the things we can do to slow the aging process? How can we delay or prevent the onset of age-related diseases? These are all questions that Matt thinks deeply about, and explores these questions with his research at the University of Washington. He is currently investigating many of these questions through the Dog Aging Project and the compound rapamycin—the only known pharmacological agent to extend lifespan all the way from yeast to mammals—across a billion years of evolution. We talk about cancer, heart disease, Alzheimer’s disease, healthspan, lifespan, and what we can do to provide longer, healthier lives for both people and dogs.

We discuss:

• Matt’s early years and his a-ha moment on aging [4:00];
• Studying dogs [6:30];
• Dogs, rapamycin, and its effects on lifespan and healthspan [15:30];
• An unexpected finding in presumably healthy dogs [36:00];
• Rapamycin in cancer treatment [50:00];
• Why isn’t there a rapamycin trial for Alzheimer’s disease (AD)? [1:01:30];
• If Matt could do a definitive study on life extension in dogs, with resources not being a concern, what does that experiment look like? [1:16:00]; and
• More.

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In this episode, my good friend David Sabatini delves into his extensive work with the mechanistic target of rapamycin—better known as mTOR—and rapamycin. The compound rapamycin is the only known pharmacological agent to extend lifespan all the way from yeast to mammals—across a billion years of evolution. David, a professor of biology and a member of the Whitehead Institute at MIT, shares his remarkable journey and discovery of mTOR in mammalian cells and its central role in nutrient sensing and longevity. Fasting, rapamycin, mTOR, autophagy, gedankenexperiments: having this conversation with David is like being the proverbial kid in the world’s greatest candy store.

We discuss:

• mTOR and David’s student years [4:30];
• Rapamycin and the discovery of mTOR [8:15];
• The connection between rapamycin, mTOR, and longevity [30:30];
• mTOR as the cell’s general contractor [34:45];
• The effect of glucose, insulin, and amino acids on mTORC1 [42:50];
• Methionine sensing and restriction [49:45];
• An intermittent approach to rapamycin [54:30];
• Rapamycin’s effects on cancer, cardiovascular disease, and neurodegeneration [57:00];
• Gedankenexperiment: couch potatoes on rapamycin vs perfectly behaved humans [1:03:15];
• David’s dream experiment with no resource constraints [1:07:00]; and
• More.

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Tom Bilyeu is the founder of Impact Theory and a co-founder of Quest Nutrition. In this episode, among the highlights, Tom provides powerful insight he’s gained through his pursuit of fulfillment which led to a billion-dollar company in Quest Nutrition. Tom makes a compelling case that it starts with a growth mindset and he’s determined to impart this knowledge into as many people as possible.

We discuss:

• Tom’s history with dieting and his changing views on fat [4:00];
• Tom’s dream of immortality [10:00];
• Life leading to Quest Nutrition and how “mindset” made the difference [18:45];
• Why Tom helped start Quest Nutrition and what made it a success [27:00];
• Why Tom started Impact Theory [35:00];
• Money and motivation [44:00];
• What Tom learned interviewing every employee at Quest, and the one question everyone answers exactly the same [54:15];
• Tom’s secret formula of fulfillment and the ubiquity of suicide [1:00:00];
• Nutrition, fasting, sleep, meditation, and other routines Tom uses to function at his best [1:13:15]; and
• More

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Pronounced, el-pee-little-a, this lipoprotein is simply described as a low density lipoprotein (LDL) that has an apoprotein “a” attached to it...but Lp(a) goes far beyond its description in terms of its structure, function, and the role that it plays in cardiovascular health and disease. Affecting about 1-in-5 people, and not on the radar of many doctors, this is a deep dive into a very important subject for people to understand.

• A quick primer on lipoproteins [7:30];
• Intro to Lp(a) [11:00];
• Lab tests for Lp(a) and reference ranges [20:00];
• The physiologic functions of Lp(a) [31:00];
• The problems associated with high Lp(a) [34:15];
• Lipid-lowering therapies of Lp(a) [44:45];
• Lp(a) modification through lifestyle intervention [1:00:45];
• High LDL-P on a ketogenic/low-carb-high-fat diet [1:05:30]; and
• More

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D.A. Wallach is a true polymath: recording artist, songwriter, essayist, investor, and so much more. In this episode, among the highlights, D.A. provides compelling and colorful insight into how the music industry works today vs the past, liquid biopsies, how to approach healthspan, cancer screening, and how we can reach a “singularity” in medicine.

We discuss:

• How to learn music as a kid and an adult [7:30];
• Chester French’s early struggles and ultimate success [16:45];
• Learning to learn, fostering curiosity in kids, and balancing creativity with structure [31:30];
• D.A.’s musical inspirations [44:30];
• History of the music industry, Spotify, and other disruptive technologies [50:00];
• The past, present, and future of medicine, hospitals, and healthcare [1:05:30];
• Investing in health [1:16:30];
• What D.A. is most excited about in the future of medicine [1:22:00];
• Liquid biopsies, how to make sense of the morass of sensitivity, specificity, positive predictive value, negative predictive value, true negatives, false positives, false negatives, and true positives in cancer screening...and the swiss cheese metaphor [1:33:00];
• The immune system, inflammation, and allergies [2:05:45]; and
• More.

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Dom digs deep into the research and application of ketogenic diets, exogenous ketones, hyperbaric oxygen treatment, and treating cancer with a metabolic approach. Plus, we lost track of the number of n=Dom experiments mentioned in this episode.

We discuss:

• Dom’s early medical training in hyperbaric chambers [7:00];
• Effect of ketones on cancer cells [20:00];
• Ketones and oxygen toxicity seizures [32:00];
• HBOT & its many applications [40:00];
• Ketones, MCTs, and exogenous ketones [59:15];
• How ketones affect blood glucose [1:20:00];
• Ketone esters, salts, enantiomers vs. racemic BOHB [1:38:00];
• Dom’s ketone tolerance test [1:56:00];
• The metabolic management of cancer with a Press-Pulse approach [1:59:45]; and
• More.

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In his first “Ask Me Anything” episode, Peter answered your questions submitted to him via Twitter.

We discuss:

• What are Peter’s thoughts on alcohol consumption and health? [4:00]
• What are the best lab tests to request from your PCP, and what are the best markers for longevity? [14:00]
• What are the best wearables and why, and why does Peter use a continuous glucose monitor? [35:00]
• How does one select the right physician as a patient? [47:00]
• Why does Peter race cars and what’s the hardest thing to learn as a new driver? [54:30]
• What is Peter’s current exercise regimen and what are his thoughts on exercise for improving lifespan and healthspan? [1:20:15]
• What is Peter’s strategy for learning something deeply? [1:33:00]
• What is Peter’s process for forming his beliefs? [1:53:30]
• What does Peter’s diet look like these days? [1:57:45]
• And more.

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Whenever I’m stumped on a patient case or in my thinking about lipids, Ron is one of the first people I turn to for insight. Ron is recognized globally for his research into lipidology and has worn many hats in his career, including clinician, lipidologist, nutrition, genetics, and drug research.

In this episode, we explore heart disease at its origins before diving into the highly discussed, largely misunderstood, role of LDL and inflammation in atherosclerosis. Ron also shares his insights on the evidence for and against statins and other lipid-lowering therapies. My hope is that both the curious patient and the physician can get a lot out of this episode by being more informed about dyslipidemia and the interventions used to reduce the risk of atherosclerotic disease. We covered a lot of ground on this critically important topic.

We discuss:

• The pathogenesis of atherosclerosis [7:00];
• How early atherosclerosis begins [12:40];
• Ron’s motivation for getting into lipidology [43:00];
• How reading an article series in the NEJM in 1967 had a profound impact on him and his career [43:30];
• How PCSK9 inhibitors work and why they may be under-utilized [47:00];
• Mendelian randomization: nature’s randomized trial [49:15];
• The “battle” between particle size and particle number [52:00];
• The use of statins [1:04:45];
• The role of chronic inflammation in atherosclerosis [1:24:15];
• Why niacin may have been unjustly dismissed as a therapeutic option [1:40:45];
• The HDL paradox: why drugs that raise HDL-C seem to raise (or have little impact on) heart disease risk [1:43:00];
• Lp(a) [1:47:45];
• And more.

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Rhonda and I go on a Nerd Safari into the jungle of health, nutrition, fitness, performance, and longevity. We visit IGF-1 and whether there’s a tradeoff of having high or low levels. We discuss the PPARs (receptor proteins) and genetic polymorphisms. Does Rhonda think there’s any benefit in a NAD+ booster for health and longevity? Can saunas lower the risk of heart disease, dementia, and all-cause mortality? 

Rhonda is a wealth of knowledge on so many topics and was the perfect companion to dig into so many fun topics in this episode. She puts a ton of thought into her research and it really shows in this conversation.

We discuss:

• What Rhonda believes differently today than she did a few years ago [5:40];
• The paradox of GH/IGF-1 in performance and longevity [21:00];
• The role of PPAR in fat metabolism and ketogenic diets [23:00];
• The possible genetic explanations for why some patients don’t respond well to a ketogenic diet [31:00];
• The health benefits of heat and cold exposure [1:12:30];
• NAD+ [1:32:45];
• And more.

Learn more at www.PeterAttiaMD.com

Excited to kick off the podcast with special guest and close friend Tim Ferriss, lifehacker, podcaster extraordinaire, and author of multiple best-selling books that includes The 4-Hour Workweek, The 4-Hour Body, Tools of Titans, and Tribe of Mentors.

In this podcast we cover mental health, depression, and our mutual interest in psychedelics as potential therapeutic agents. Tim talks both experientially and from his own deep dive into the literature of psychedelics and mental health. Tim is shifting his focus from investing in startups to funding experiments that he hopes will establish more reliable knowledge and therapeutic options for those suffering from anxiety, depression, and addiction.

Tim also shared his list of acquired wisdom he returns to most reliably, which might be worth the price of admission alone.

We discuss:

• Tim’s history of depression and his TED Talk on his close call with suicide [11:15];
• The type of thinking that triggers Tim’s downward spirals [17:15];
• Tim’s transformative experience with ayahuasca [48:45];
• How Tim’s experience and research has led him to focus on furthering the science on psychedelics and mental health [53:00];
• What some of the meditation modalities, and meditation apps, are out there, why meditation can be so hard to do, but also worthwhile to stick with [1:13:00];
• Why Tim made a big commitment (more than $1 million) to funding scientific research, and to psilocybin and MDMA research, in particular [1:31:00];
• From all the habits and tools that Tim has learned, the five things that he returns to most reliably [2:33:00];
• And more.

Learn more at www.PeterAttiaMD.com

Welcome to a special sneak peek of The Peter Attia Drive. The Peter Attia Drive will feature guests and experts that will offer advice and insight to help you optimize performance, health, longevity, critical thinking, and life. It’s hosted by Stanford M.D., TED speaker, and longevity expert Dr. Peter Attia, founder of Attia Medical, PC, a medical practice with offices in San Diego and New York City.

Learn more at www.PeterAttiaMD.com