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

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We discuss:

• Phil’s background in running, and training insights from a six-day race (2:30);
• The difference between being “fit” and being “healthy” (11:00);
• Defining the aerobic and anaerobic systems, and why VO2 max doesn’t predict performance (18:15);
• Defining maximum aerobic function (MAF), determining your MAF heart rate with Phil’s 180 Formula, and why a strong aerobic system is crucial to health and performance (24:00);
• Using the MAF test to track and improve your aerobic fitness (37:30);
• How increasing your sub-max pace at a given heart rate can increase your maximum pace (40:00);
• The impact of nutrition on one’s ability to use fat as fuel while exercising (43:00);
• Phil’s nutritional approach with patients, the concept of “carbohydrate intolerance” (51:45);
• Assessing the impact of a low-carb diet on high intensity exercise and anaerobic performance (58:00);
• Extracting insights from world-class marathoners (1:04:45);
• How being “overfat” affects health and performance, and ways to decrease excess body fat (1:13:30); and
• More.

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Robert Abbott is a six-time Emmy award winner and the director of “The Last Days of Knight,” the behind-the-scenes documentary of legendary coach Bobby Knight, and the events that led to his termination from Indiana University. In this episode, Robert takes us through his investigative journey, which revealed cautionary tales of a winning at all costs environment—how pain often gets left in the wake of unchecked anger, ego, and perfectionism. Robert reflects on Knight’s legacy and extracts lessons in self-awareness and accountability that can be applied to ensure history doesn’t repeat itself.

We discuss:

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

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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.

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.

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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.

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.

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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.

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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.

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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.

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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

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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.

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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:

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.

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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.

• 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.

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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.

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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.

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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.

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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.

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.

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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.

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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.

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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

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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.
  

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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.

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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.

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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.

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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.
    

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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/  

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In this episode, Dr. Paul Grewal, M.D. joins Peter to discuss what they have learned in the past week in the midst of the rapid changes surrounding the COVID-19 pandemic. Their conversation touches on both optimism and uncertainty: actionable steps we can take to improve the situation with the understanding that it is too late for viral containment. Specifically, Peter and Paul discuss some promising drug treatment, reasons for isolating-behavior adoption, and what they are personally instituting in their own lives.

Disclaimer: This is information accurate as of March 13, 2020, when it was recorded.

We discuss:

• When the gravity of Coronavirus (COVID-19) hit home [04:30];
  
• Hospitalization and ICU bed space as an issue [8:15];
  
• Natural history and pathology of COVID-19 [12:00];
  
• Potential drug therapies [22:00];
  
• How thinking has changed from containment to management [30:00];
  
• What Paul and Peter are doing [49:00];
  
• What we know about viral transmission [57:00]; and
  
• More.

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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.

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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.

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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

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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/ 

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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

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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 

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

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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/ 

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In my first interview with Jason Fried, Jason explained his overall philosophy about work-life balance and how exactly he optimizes for efficiency. For this special follow-up AMA, we've decided to release the full episode to everyone (including non-subscribers), so all can hear Jason answer questions from listeners that dive deeper into topics such as work-life balance, the role of luck versus hard work in success, specifics around Basecamp’s unique process-oriented approach to projects, 4-day work weeks, practical tips for people searching for the right company culture, tips on writing and parenting, and a whole bunch more.

• If Jason had taken his own advice about work-life balance at the start of his career, would he have achieved the same level of success? [2:05];

• What is Jason’s definition of success, and what is he optimizing for? [10:10];

• Basecamp’s policy on email and expectations for a quick response, and why Jason believes in sleeping on big decisions [14:30];

• How Jason implements “true” work-life balance in his life and at Basecamp [19:15];

• Does work and life have to be separated in order to have balance? [32:00];

• How Jason makes time the fixed component to avoid the compulsion to keep pushing forward on a project perpetually [34:15];

• Jason’s tip for physicians who may be facing burnout [45:00];

• Signs of “burnout” if you do the same thing for work and pleasure, and tips to avoid and manage that feeling [49:45];

• Is a 40-hour work week the correct amount? [53:45];

• How to evaluate a company’s culture when looking for a job with the right work environment [59:00];

• Jason’s take on salaries and alternate incentives like equity, profit sharing, etc. [1:06:45];

• What traits does Jason look for when hiring new employees? [1:13:45];

• Does Jason believe in process-oriented work or outcome-driven work, and Basecamp’s unique process for completing projects [1:16:15];

• How does Jason handle a project that results in a failure? [1:20:00];

• Advice for people in situations where they don’t have full control of their time and work demands [1:23:50];

• How much of success should be attributed to skill versus luck? [1:29:30];

• The importance of writing skills, and tip to improve your writing [1:43:15];

• Lessons learned from parenting, and Peter’s top priority when it comes to raising kids [1:52:15];

• An important skill: the ability to say “no” to things [2:01:15]; and

• More.

Learn more: https://peterattiamd.com/

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

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Today's episode of The Qualys is from podcast #04 – AMA #1: alcohol, best lab tests, wearables, finding the right doc, racing, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ 

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In this “Ask Me Anything” (AMA) episode, Peter explains the various levers one can pull to affect longevity with a specific focus on the strategies and tactics one can implement that do not require the help of a physician. 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 #12 show notes page.

We discuss:

• The five levers you can pull to affect longevity [1:15];

• Nutritional biochemistry: Framework, 3 nutritional interventions, and how to approach your goals, and what you should be tracking [4:30];

• Exercise for brain health, and the 4 components of exercise [20:45];

• Exercise component—Stability [24:30];

• Exercise component—Strength [29:00];

• What is Peter optimizing for with his exercise? [30:30];

• Exercise components—Zone 2 and zone 5 training [33:15];

• More about DNS, and why we need to be careful with rushing kids through neuromuscular development stages [45:00];

• Sleep: How to improve quantity and quality [48:15]; and

• More.

Learn more: https://peterattiamd.com/

Show notes page for this episode:  https://peterattiamd.com/AMA12

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Today's episode of The Qualys is from podcast #03 – Ron Krauss, M.D.: a deep dive into heart disease.

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/ 

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In this episode, Dr. Eric Topol, founder and director of the Scripps Research Translational Institute, shares how artificial intelligence and deep learning is currently impacting medicine and how it could transform the healthcare industry, not only in terms of the technological advancements, but also in restoring the patient-doctor relationship for better patient outcomes and experiences. We also discuss Eric’s rich and fascinating career in cardiology as well as his involvement as one of the first outspoken researchers to question the cardiovascular safety of Vioxx.

We discuss:

• Eric’s background and his source of interest in cardiology [3:15];
  
• The US medical field’s resistance to technological change and learning from other healthcare models [11:15];
  
• Eric’s mission at the Cleveland Clinic [20:15];
  
• How Eric helped to elucidate the issues with Vioxx (and why he came to regret it) [29:45];
  
• How Eric came to found one of the most influential research centers in the world [47:30];
  
• How AI and deep learning is currently impacting medicine, and the future possibilities [56:30];
  
• Gut microbiome—Its role in health, impact on glycemic response and fuel partitioning, and how deep learning could improve our research and treatment [1:17:45];
  
• Why machines combined with human doctors is superior to one without the other [1:32:00];
  
• How AI and machines can reinstate medicine as an attractive career (and alleviate physician burnout) [1:36:45];
  
• Eric’s dream experiment [1:47:15] and;
  
• More.

Learn more: https://peterattiamd.com/

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

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Today's episode of The Qualys is from podcast #14 – Robert Lustig, M.D., M.S.L.: fructose, processed food, NAFLD, and changing the food system.

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/ 

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In this episode, Ryan Holiday, author of Stillness is the Key, shares the profound impact that stoic philosophy has had on his personal life and his career as a successful writer. Ryan stresses the importance of stillness in a modern world set up to encourage the opposite and lays out the best strategies to develop stillness in your life. He also explains the destructive nature of being driven by ego, as well as the perils of jealousy and anger, and provides practical steps you can take to avoid those harmful states.

We discuss:

• Has a more connected world improved or worsened our lives? [2:15];
  
• Consequences of an overly secure life, living in the present, & the misconception of unlimited time [5:45];
  
• Stoicism 101: The definition and origins of stoic philosophy [15:45];
  
• Ryan’s career transition into writing, and his take on what makes a book or business successful [26:45];
  
• Storytelling—The upside and downside of telling stories and self-narrative [36:15];
• Does achieving success have to come from a place of craving and proving others wrong? And what are the costs of building a legacy? [38:45];
  
• Ego—confusing ego with confidence, signs your ego is showing, & antidotes to the negative effects of ego [52:45];
  
• Ryan’s advice to Peter about writing (and finishing) his book [1:06:30];
  
• Stillness—what it is, how it compares to meditation, & the obstacles to achieving stillness [1:10:30];
  
• Ryan’s morning routine, relationship with his smartphone, and how he avoids falling victim to the trappings of technology and a hyperconnected world [1:17:40];
  
• The perils of jealousy and envy [1:24:15];
  
• How to live in the moment in a modern world not designed for stillness [1:32:15];
  
• How the idea of “dying well” can help you live better [1:36:00];
  
• How has fatherhood impacted Ryan’s philosophies on stillness and living in the moment? [1:39:45];
  
• How to make your favorite day your every day [1:42:00];
  
• The most reliable strategies for developing stillness [1:47:30];
  
• Anger—what the stoics say about anger, outrage in politics, & why more anger isn’t the solution [2:02:00];
  
• How to follow Ryan’s work [2:12:00]; and
  
• More.
  

Learn more: https://peterattiamd.com/

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

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Today's episode of The Qualys is from podcast #28 – Mark and Chris Bell: steroids, powerlifting, addiction, diet, training, helping others, documentaries, and living your best life.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ 

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD 

In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of fasting-specific questions from subscribers. Peter starts by defining the various fasting protocols, details his own personal fasting regimen, explains his revised plan for 2020, and provides a ton of value to anyone interested in fasting. 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 #11 show notes page.

We discuss:

• Defining the various fasting protocols [1:00];
  
• Why Peter plans to switch to a 3-day fast once per month in 2020 [11:00];
  
• How Peter uses his CGM to gain insights into the depth of fast [13:15];
  
• Peter’s supplement protocol during fasting, and why he eats a ketogenic diet leading up to a prolonged fast [17:00];
  
• Peter’s exercise regimen during a fast [23:30];
  
• Peter’s hunger levels during a typical 7-day fast [26:45];
  
• Fasting observations—Core body temperature and thyroid hormone [30:30];
  
• Fasting observations—Glucose, BHB, and hunger levels [33:15];
  
• Peter’s sleep protocol during a fast [40:15];
  
• Does Peter observe any differences between men and women in their ability to fast? [47:00];
  
• How Peter prefers to break a long fast [50:15];
  
• Importance of community support while fasting, and is there a perfect fasting protocol? [52:00]; and
  
• More.
  

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/ama11/

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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 

In this episode, Paul Grewal, internal medicine physician and co-author of Genius Foods, discusses what has got him so focused on lifestyle changes for metabolic health which was partly brought on by his own experience of losing almost 100 pounds at two points in his life. Paul and Peter discuss how the results from a NuSI-funded study has impacted their feelings about the supposed “metabolic advantage” of a low-carb diet. Paul then makes the case for what he calls the “active poisoning” of the American food supply, defines his five phenotypes of obesity manifestation, as well as lays out his nutritional and training approach with his patients (as well as himself personally). Overall, this discussion is a treasure trove of topics from endocrinology, insulin resistance, caloric restriction, fasting, exercise, causes of obesity, LDL and heart disease, and much more.

We discuss:

• Paul’s health story—two instances of major weight loss [3:15];
  
• The multiplication of adipocytes after weight loss, and why an obese adult that was overweight in childhood is harder to treat than adult-onset obesity [7:30];
  
• Low-carb diets—Is there a metabolic advantage in energy expenditure? (And Peter’s take on the NUSI study) [12:45];
• The relationship between hyperinsulinemia and hyperglycemia—which is causing which? [27:00];
  
• Weight gain—Which macronutrients are driving it, processed foods, and overfeeding studies [31:15];
  
• The active poisoning of our food supply with processed foods [36:15];
  
• The role of fructose in metabolic disease and NAFLD [39:00];
  
• Where traditional medicine falls short in the real world and why “functional medicine” is gaining steam [45:45];
  
• Relationship between heart disease and LDL, residual risk, LDL clearance problem, and a patient case study [54:00];
  
• Relationship between heart disease and fatty acids (SFA, PUFA, seed oils, etc.) [1:04:30];
  
• Paul’s nutritional approach with patients [1:12:30];
  
• High-carb/low-fat diet for muscle gain, and the “reverse diet” to combat the slowdown of metabolism after caloric restriction/weight loss [1:15:00];
  
• Fasting—ideal duration, how to preserve muscle mass, and the ultimate tool of medicine [1:23:30];
  
• The 5 phenotypes of obesity, and the impact of carbs, cortisol, and sleep on adiposity [1:28:30];
  
• Uric acid [1:38:15];
  
• Paul’s 2nd big physical transformation—How he did it and kept the weight off [1:39:15];
  
• Paul and Peter’s personal struggles with food, internal dialogue, and self-image [1:45:00];
  
• Paul’s personal nutritional strategy (and how his exercise influences it) [1:52:00];
  
• A low-fat diet Peter is willing to try [2:00:40];
• The keto diet for competitive athletes [2:05:00];
  
• How Peter prescribes exercise to his patients [2:08:30];
  
• Calculating glycogen depletion and RQ, creatinine-kinase system, Tabata workouts, and more [2:10:30]; and
  
• More.

Learn more: https://peterattiamd.com/

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

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Today's episode of The Qualys is from podcast #31 – Navdeep Chandel, Ph.D.: metabolism, mitochondria, and metformin in health and disease.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ 

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

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

We discuss: 

• The connection between blood pressure and fructose that shifted Rick’s professional focus [4:00];
  
• The relationship between salt and blood pressure (and the role of sugar) [5:45];
  
• Defining fructose, glucose, and sugar [19:30];
  
• An ancient mutation in apes that explains why humans turn fructose into fat so easily [23:00];
  
• The problems with elevated uric acid levels, and what it tells us about how sugar causes disease [31:30];
  
• How sugar causes obesity—explaining the difference in glucose vs. fructose metabolism and the critical pathway induced by fructose [40:00];
  
• Why drinking sugar is worse than eating it [50:00];
  
• Unique ability of sugar to drive oxidative stress to the mitochondria, insulin resistance, and diabetes [54:00];
  
• Why cancer loves fructose [1:00:15];
  
• The many areas of the body that can use fructose [1:05:00];
  
• Fructokinase inhibitors—a potential blockbuster? [1:07:15];
  
• Treating high uric acid levels—Rick’s approach with patients [1:10:00];
  
• Salt intake—what advice does Rick give his patients? [1:16:30];
  
• How excess glucose (i.e., high carb diets) can cause problems even in the absence of fructose [1:21:00];
  
• Artificial sweeteners vs. real sugar—which is better? [1:29:15];
  
• Umami, MSG, alcohol, beer—do these have a role in metabolic illness? [1:33:45];
  
• Fructose consumption—Is any amount acceptable? Is fruit okay? Where does Rick draw a hard line? [1:38:45]
  
• How does Rick manage the sugar intake of his young kids? [1:43:00]; and
  
• More.

Learn more: https://peterattiamd.com/

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

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Today's episode of The Qualys is from podcast #06 – D.A. Wallach: music, medicine, longevity, and disruptive technologies.

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/  

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In this episode, Damon Hill, 1996 Formula 1 World Champion, opens up about his personal struggles with depression, feelings of inadequacy, loss of identity, and his ultimate path to healing following his remarkable racing career. Damon’s life was given a tragic jolt at 15 years of age when his father and legendary F1 driver Graham Hill died suddenly—the common string that ties together so much of his life and has forged so much of who he is to this day. We discuss Damon’s unique and remarkable racing career including his legendary battles with Michael Schumacher as well as Damon's firsthand account of what happened that tragic day on May 1st, 1994, when his teammate, Ayrton Senna, died at Imola. But this is not just about racing; rather it’s a human story that's cloaked in a racing one.

Learn more: https://peterattiamd.com/

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

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Today's episode of The Qualys is from podcast #03 – Ron Krauss, M.D.: a deep dive into heart disease.

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/ 

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In this episode, Dr. Iñigo San Millán, Assistant Professor at the University of Colorado School of Medicine, explains the crucial role of mitochondrial function in everything from metabolic health to elite exercise performance. Iñigo provides a masterclass into the many different energy system pathways, the various fuel sources (including the misunderstood lactate), the six zones of exercise training, and the parameters he uses to measure metabolic health. Additionally, he highlights the power of zone 2 training in its ability to act as a powerful diagnostic tool, and perhaps more importantly as a treatment for mitochondrial and metabolic dysfunction.

We discuss:

• Iñigo’s background in sports and decision to focus on education [7:15];

• Explaining the various energy systems and fuels used during exercise [14:45];

• Iñigo qualifies energy systems into six training zones [26:00]; 

• Lactate is an important fuel source [33:00];

• Zone 2 training—physiologic characteristics, fuel sources, lactate, and the transition into zone 3 [40:30];

• Using blood lactate levels (and zone-2 threshold) to assess mitochondrial function [47:00];

• Accessing mitochondrial function by looking at one’s ability to utilize fat as fuel (with an RQ test) [55:00];

• Athletes vs. metabolically ill patients—mitochondria, fat oxidation, muscle glycogen capacity, “fat droplets”, and more [1:00:00];

• Physiologic characteristics of zone 3, zone 4, and the lactate threshold [1:20:00];

• Fueling exercise—dietary implications on glycolytic function [1:30:30];

• Relationship between exercise and insulin sensitivity (and what we can learn from studying patients with type 1 diabetes) [1:46:30];

• Metformin’s impact on mitochondrial function, lactate production, and how this affects the benefits of exercise [2:04:15];

• Raising awareness for risk of “double diabetes” [2:15:00];

• How to dose zone 2 training, and balancing exercise with nutrition [2:18:00];

• Proposed explanation of the Warburg Effect: Role of lactate in carcinogenesis [2:27:00];

• Doping in cycling, and the trend towards altitude training [2:39:15] and;

• More.

Learn more: https://peterattiamd.com/

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

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Today's episode of The Qualys is from podcast #25 – Scott Harrison: transformation, finding meaning, and taking on the global water crisis.

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/ 

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In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter’s head of research, asks the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA.

If you’re a subscriber, you can now listen to this full episode on your private RSS feed. You can also listen to this full episode on our website at the AMA #10 show notes page.

We discuss:

• Does testosterone supplementation impact longevity? [2:40];
  
• Under what conditions does Peter decide to treat patients who have low testosterone? [8:50];
  
• Are there risks involved with testosterone replacement therapy? [17:10];
  
• How does Peter diagnose and treat hypothyroidism? [21:30];
  
• How might someone do time-restricted feeding while also adding muscle mass? [26:30];
  
• If building muscle requires higher levels of IGF-1, should we be concerned about longevity? [34:45];
  
• How to preserve muscle mass while fasting [41:45];
  
• Is it possible to simultaneously lose fat and add muscle mass? [46:30]; and
  
• More.

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/ama10

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Today's episode of The Qualys is from podcast #14 – Robert Lustig, M.D., M.S.L.: fructose, processed food, NAFLD, and changing the food system.

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/ 

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In this episode, Bill Harris, Ph.D. in human nutrition and expert on omega-3 fatty acids, sets the table by clearly defining the families of fatty acids (saturated, monounsaturated, polyunsaturated) before diving into the current landscape of polyunsaturated fat (omega-6 and omega-3) with a particular focus on EPA and DHA (the two main elements of fish oil supplements). Bill gives a historical overview, updates us on the latest science related to the health benefits, and provides plenty of insights as to how we should think about increasing our EPA and DHA intake.

We discuss:

• Bill’s long history of studying fatty acids [6:30];
  
• Defining the fatty acids—SFA, MUFA, PUFA, omega-3, omega-6, and more [9:45];
  
• What is the significance of fatty acids? Why should we care? [19:45];
  
• History of fat phobia, saturated fat, and does PUFA reduce cholesterol? [23:45];
  
• Breaking down the conversion process of omega-6 and omega-3 fatty acids including how we get to EPA and DHA [28:00];
  
• Takeaway from Bill’s 1980 study looking at how salmon oil affected cholesterol and triglyceride levels [36:15];
  
• History of our understanding of omega-3 and its effect on LDL cholesterol [45:00];
  
• Prescribed fish oil drugs vs. OTC supplements—Differences and recommended brands [52:00];
  
• Health benefits of EPA [57:45];
  
• Potential benefits of ALA and how it compares to taking EPA and DHA directly [1:12:45];
  
• Health benefits of DHA [1:17:15];
  
• Cell membrane omega-3 index—What is it, the role of genetics, how to increase it, and a recommended target [1:19:00];
  
• Is EPA or DHA neuroprotective? Can it help with depression? [1:23:30];
  
• Recommended fish to eat for EPA and DHA - Any mercury concerns? [1:25:45];
  
• Can omega-3 mitigate risks associated with smoking? [1:29:15];
  
• The problem with the omega-6 to omega-3 ratio [1:30:00];
  
• The problem with labeling any kind of fatty acid as “bad” [1:36:00];
  
• Why increasing EPA and DHA intake matters more than reducing omega-6 intake [1:38:00];
  
• Important takeaway from the VITAL study [1:46:30];
  
• Importance of testing your omega-3 index [1:53:00];
  
• Exciting study coming out soon, and why you need to take your fish oil with food [1:57:15]; and
  
• More.
  

Learn more: https://peterattiamd.com/

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

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Today's episode of The Qualys is from podcast #14 – Robert Lustig, M.D., M.S.L.: fructose, processed food, NAFLD, and changing the food system.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ 

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD 

In this episode, Mark Messier, six-time Stanley Cup champion, shares the most valuable lessons he picked up over 25+ years of professional hockey resulting in one of the longest and most decorated careers in hockey history. Mark shares what lead to his unique brand of humble leadership, how he was able to get talented individuals to effectively work as a team, the importance of maturing and evolving as a person, and how he was able to stay calm and perform at his best under enormous amounts of pressure. Additionally, we go through his favorite moments as a player, what it was like playing with and learning from The Great One, Wayne Gretzky, and much more.

We discuss:

• Overview of Mark’s extraordinary 25+ year professional hockey career [7:15];
  
• The trend towards kids focusing on one sport earlier and earlier—A good or bad thing? [12:00];
  
• Mark’s early passion for hockey, and when he realized it could be his “job” [14:15];
  
• Going pro at age 17 [19:30];
  
• Mark’s favorite experience playing professional hockey [25:45];
  
• Playing with (and learning from) the great Wayne Gretzky [26:40];
  
• A hard lesson learned in his first year as a pro [32:00];
  
• Lessons learned from losing his first Stanley Cup Finals [35:45];
  
• Redemption—Winning his first Stanley Cup and the beginning of a dynasty in Edmonton [41:15];
  
• Importance of team character [54:00];
  
• The shocking trade of Wayne Gretzky, and Mark stepping up as the new leader and team captain [59:30];
  
• Playing for the New York Rangers—the lure of the city and the pressure to perform [1:07:00];
  
• Ending the 54-year championship drought for the New York Rangers [1:13:30];
  
• Becoming a great leader [1:16:30];
  
• How to win the mental war against your opponent [1:20:30];
  
• Opposing players for which Mark had great respect [1:22:00];
  
• Retiring after an unbelievably long and lustrous career [1:27:00];
  
• How to leverage stress and nervousness into a positive force [1:32:45];
  
• The most important quality—A willingness to learn, improve, and evolve [1:36:00];
  
• What does Mark do today for exercise to stay in great shape? [1:44:30];
  
• Why playing sports is such a great thing for kids [1:49:30];
• The Mark Messier Foundation [1:53:00];
  
• How has Mark avoided the “loss of identity” feeling which plagues many retired athletes? [1:56:15];
  
• Does Mark think it’s possible to reproduce a team as good as his Oilers teams of the 80s? [1:59:30];
  
• Would Mark ever want to coach in the NHL? [2:03:00];
  
• Will the Toronto Maple Leafs ever win the Stanley cup? [2:04:00]; and
  
• More.
  

Learn more: https://peterattiamd.com/

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

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Today's episode of The Qualys is from podcast #32 – Siddhartha Mukherjee, M.D., Ph.D.: new frontiers in cancer therapy, medicine, and the writing process. 

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/ 

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In this episode, Dr. Debra Kimless and Steve Goldner share their knowledge on the science, policy, and market evolution of medicinal cannabis. We start with the differences between THC and CBD, how they work in the body, and how they act on the brain. We discuss the many potential benefits of using CBD, THC, hemp in the various forms of administration (smoking, vaping, edibles, oils, etc.) as well as some of the safety issues including the recent uptick in incidents of hospitalization and death linked to vaping. Debra and Steve are both involved with the company, Pure Green—Debra the Chief Medical Officer and Steve the founder and CEO—whose aim is to create the safest, most efficacious form of delivery of cannabis. Their bigger mission is to shift the perception of the cannabis plant, garner acceptance of its medicinal benefits, and ultimately get it descheduled on a federal level so more people can access cannabis for a range of chronic ailments.

We discuss:

• Debra and Steve’s background reason for their interest in medical cannabis [7:00];
  
• The history of medical use of cannabis [11:15];
  
• How THC, CBD, and other cannabinoids work [16:00];
  
• Hemp—What it is, special uses, and the 2018 farm bill [22:45];
  
• The legal status of CBD, Deb and Steve’s clinical trial, and how CBD differs from THC [30:15];
  
• The safety profile of THC [35:00];
  
• Is marijuana as a gateway drug? [45:30];
  
• Smoking vs. vaping vs. edibles—Benefits, risks, and mechanistic differences [53:30];
  
• Can you build up a tolerance to the effects of THC? [1:15:00];
  
• What do people generally want to get from using marijuana? [1:17:15];
  
• Cannabinoid synthetics [1:22:30];
  
• Efficacy of CBD oils as a sleep aid [1:25:00];
  
• Pure Green Cannabis [1:30:30];
  
• Anecdotal evidence and managing the hype surrounding cannabis in medical treatment [1:38:45];
  
• Aspirations for the future of medicinal cannabis, and the legal challenges that await them [1:45:15];
  
• Descheduling cannabis: A human rights issue [2:04:00] and;
  
• More.

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/debrakimless-stevegoldner/

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Today's episode of The Qualys is from podcast #10 – Matt Kaeberlein, Ph.D.: rapamycin and dogs — man’s best friends? — living longer, healthier lives and turning back the clock on aging and age-related diseases.

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/ 

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In this special, bonus celebrity AMA episode, Peter answers questions from former Olympians and past guests, Apolo Ohno and Sasha Cohen, on a wide range of subjects including fasting, learning, training for performance versus longevity, and much more. This bonus AMA is available in full to everyone.

• Apolo's questions begin [1:45];
  
• Why women may have a harder time fasting, and tips for those who are struggling [2:10];
  
• Is there any place for fasting as part of a nutritional strategy in adolescents? [6:15];
  
• Tips for learning and retaining large amounts of new information (and the best nutritional approach) [9:15];
  
• Must read books of 2019 [14:45;
  
• If you could only keep a few watches for the rest of your life which would they be? [16:45];
  
• What workout would Peter do inside a hotel room? [22:15];
  
• What is Peter’s ultimate gorge meal? [23:45];
  
• How do you foresee fasting as a mechanism for performance in athletes? [25:30];
  
• What is driving Peter to strive for excellence? [33:30];
  
• Sasha's questions begin [38:40];
  
• What are you most excited about in the longevity space? [38:45];
  
• At what point do you see enough data or proof that a new drug, or type of fasting is worth trying it out for yourself? [41:30];
  
• Is it possible to obsess so much about your health that it becomes a negative stressor? [46:45];
  
• Which tests are worth doing if you want to be proactive about your health? [48:15];
  
• Are there any supplements Peter things are beneficial to be taking? [55:15];
  
• How does Peter’s training differ when optimizing for performance versus longevity? [56:30];
  
• How does taking testosterone and growth hormone affect performance versus longevity? [59:15]; and
  
• More.

Learn more: https://peterattiamd.com/

Show notes page for this episode:https://peterattiamd.com/celebrityama01

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Today's episode of The Qualys is from podcast #02 – Rhonda Patrick, Ph.D.: the performance and longevity paradox of IGF-1, ketogenic diets and genetics, the health benefits of sauna, NAD+, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ 

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

In this episode, Ric Elias, founder of Red Ventures, opens up about the fateful day he knew for certain that he was going to die as a passenger on US Airways Flight 1549. Ric dives deep into how that day impacted his life, greatly changed his perspective, and improved his relationship with his family and the broader community. We also talk about his incredible role as CEO of an enormous company, his remarkable work in philanthropy, and all the wisdom he has acquired in his extraordinary life.

We discuss:

• Ric’s life leading up to the day of the plane crash [5:30];
  
• The plane crash—What it’s like knowing you’re about to die, feelings of regret and sadness [11:15];
  
• The improbable plane landing in the Hudson River [19:00];
  
• Emotions after the safe landing (and a story he’s never told before) [25:45];
  
• A powerful story about Captain Sully [29:30];
  
• Earning his second chance at life, and playing the “infinite game” [38:30];
  
• Why time is the ultimate currency, and how (and why) to say “no” [46:15];
  
• Raising kids in an achievement culture, Ric’s definition of life success, and what Ric wants to instill in his kids [53:00];
  
• What Ric believes is actually worth getting upset, and the organizations that are taking steps to help people [1:09:00];
  
• The core principles of Red Ventures (Ric’s company) [1:19:15];
  
• Ric’s tips for developing business acumen and negotiation skills [1:29:30];
  
• What qualities does Ric look for in people he wants to work with? [1:32:50];
  
• What is the next big problem that Ric wants to solve? [1:35:30];
  
• What is the most challenging part of your business today? [1:37:30];
  
• If Ric could go back and talk to himself in the morning before getting on that plane, what would he say? [1:39:15]; and
  
• More.

Learn more: https://peterattiamd.com/

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

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Today's episode of The Qualys is from podcast #39 – Ted Schaeffer, M.D., Ph.D.: How to catch, treat, and survive prostate 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/ 

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In this episode, Sasha Cohen, former US Olympic figure skater, discusses the most challenging things about life as an Olympian—the pressures, the expectations, years of sacrifice, but worst of all a loss of identity post-career resulting in many former Olympians suffering from depression. We begin by talking about everything that led up to her unforgettable moment from the 2006 Olympics, and how she handled herself so beautifully in the face of disaster. Most importantly, we talk about post-skating life when she shares many insights such as the downside of constantly striving for a moment, the hollowness of achievement, and the importance of redefining our definition of success.

We discuss:

• Sasha’s mindset going into the 2006 Olympics as the favorite [6:30];
  
• Figure skating basics, scoring, short program vs. long program, etc. [13:40];
  
• Sasha’s unforgettable performance at the 2006 Olympics [18:10];
  
• Win, lose, or draw, why many Olympians suffer from a loss of identity [32:30];
  
• Dealing with the disappointment of “losing the gold” [40:30];
  
• The tiny window of opportunity for Olympians, and the overwhelming pressure to meet expectations [49:30];
  
• Sasha’s unique childhood, finding figure skating, and channeling her hyperactive personality into becoming an amazing skater [1:01:30];
  
• The consequences of extreme training at a young age, and trying to control the uncontrollable [1:10:00];
  
• What is driving extreme athletes and Olympians to be the best? [1:18:30];
  
• Why many former Olympians and athletes struggle with depression [1:25:00];
  
• Refining success—How Sasha overcame her own loss of identity [1:32:30];
  
• What advice would Sasha give her 15-year-old self? [1:40:45];
  
• Lessons we can learn from watching the rapid downfall of many former Olympians [1:45:00];
  
• Advice for people who are tying their identity to being “successful” or striving to be “the best” [1:56:00];
  
• Life lessons Sasha wants to apply to being a mother to her baby boy she is expecting [2:05:00]; and
  
• More.

Learn more: https://peterattiamd.com/

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

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Today's episode of The Qualys is from podcast #26 – AMA #3: supplements, women’s health, patient care, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

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In this special episode, Matthew Walker returns for his second AMA episode where he provides his expert insight on numerous sleep-related questions directly from listeners. He answers a wide range of questions from the gene that causes the short sleeping phenotype, to the ideal sleeping position, to the optimal temperature for best sleep, to how fasting affects sleep, plus a full dissertation on sleep apnea, and much, much more.

We discuss:

• DEC2—A genetic mutation that produces a short sleeping phenotype [11:00];
  
• What is the best position to sleep in? [22:45];
  
• Should you consider a “sleep divorce” with your partner? [27:00];
  
• The challenge of kids wanting to sleep in bed with their parents [28:45];
  
• Is there an ideal type of pillow? [32:30];
  
• Any data on hammock sleeping? Should adults be rocked to sleep like a baby? [34:45];
  
• The optimal room temperature and body temperature for the best sleep [38:30];
  
• Do humidifiers help? [50:40];
  
• How do high altitudes affect sleep? [53:15];
  
• What is the data on weighted blankets (e.g., the Gravity blanket)? [57:00];
  
• Caffeine—How much, and in what way, does it affect sleep? [58:15];
  
• How does sexual activity relate to sleep quality? [1:04:00];
  
• Should we be sleeping in two phases? First sleep & second sleep? [1:06:30];
  
• Napping—Is there ideal duration? Should we be napping or not? [1:08:30];
• Advice for new parents dealing with sleep deprivation [1:12:00];
  
• Understanding your sleep chronotype [1:16:15];
  
• If you drink too much alcohol in a given night, is there anything you can do to make sure your sleep isn’t wrecked? [1:20:45];
  
• How postmenopausal women can manage their sleep problems with (and without) hormone replacement therapy [1:23:00];
  
• Could a daily practice of Wim Hof's breathing method help or hinder quality of sleep? [1:29:15];
  
• Why do some people paradoxically feel more tired the more they sleep? [1:31:15];
  
• Sleep apnea—How to know if you have it, the different types, the causes, and helpful resources [1:33:15];
  
• Is there such a thing called “sleep eating”? [1:45:00];
  
• If Matt was “sleep czar”, what changes would he make to society to improve sleep? [1:46:15];
  
• Catch up sleep: Explaining the difference between retrospective damage and prospective benefit [1:48:45];
  
• Does poor sleep really speed up the aging process? [1:50:30];
  
• Is medicated sleep better than no sleep? [1:53:00];
  
• Does vivid dreaming disrupt the sleep cycle? [1:56:45];
  
• Is there potential benefit to using “binaural beats” or some type of sound to induce better sleep? [1:57:45];
  
• How is sleep affected by fasting and time-restricted eating? [1:59:45];
  
• Is there any evidence that polyphasic sleep (e.g., "Uberman") works? [2:03:30]; and
  
• More.

Learn more: https://peterattiamd.com/

Show notes page for this episode: peterattiamd.com/matthewwalkerama2/

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Today's episode of The Qualys is from podcast #09 – David Sabatini, M.D., Ph.D.: rapamycin and the discovery of mTOR — the nexus of aging and longevity?.

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/ 

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In this episode, Kyle Kingsbury, retired UFC fighter and director of human optimization at Onnit, discusses the purpose and meaning that football and MMA gave him but which also acted as a distraction from his inner demons. Kyle opens up about his use of PEDs (steroids, testosterone, HGH) in college and talks about some of the misconceptions around them. Next, Kyle talks about his battle with depression and a close call with suicide that lead to life-changing experiences with psilocybin and ayahuasca—which really became the turning point in his own journey towards being more emotionally healthy, finding inner peace, and being a better husband and father. *DISCLAIMER: The substances spoken about in this episode are illegal and by no means are we advocating for anyone to use them or experiment with them. There are physical, physiological, psychological, and legal risks around the use of these plants. This conversation is purely informational only.

We discuss:

• Growing up in a volatile home [6:30];
  
• Playing college football at ASU, and letting go of NFL aspirations [15:45];
  
• Kyle’s experience taking anabolics (steroids/testosterone), misunderstood science, and fear mongering [23:15];
  
• Kyle’s experience with taking HGH [35:30];
  
• The Whizzinator [36:45];
  
• Struggles with depression and drugs, and a lack of meaning after football [41:00];
  
• Kyle’s close call with suicide, and a spiritual experience [47:15];
  
• Finding refuge with mixed martial arts, and Kyle’s early success in cage fighting [52:30];
  
• Lessons from Kyle’s first loss in fighting, and training for the UFC [59:45];
  
• First experiences with psilocybin and ayahuasca, quieting the monkey mind, and finding inner peace [1:07:15];
  
• Overt vs. covert depression, depression in men vs. women, and the transition from adaptive to maladaptive behaviors [1:16:00];
  
• Peeling back the layers with ayahuasca: Kyle tells stories about the most transformative experiences with psychedelics [1:19:00];
  
• Does Kyle feel like he has lost his “edge” as a result of his journey? [1:26:15];
  
• Where would Kyle be had he not discovered the power of psychedelic medicines? [1:29:45];
  
• Parenting: Stopping the cycle of trauma, reconnecting to our ancestral roots, and Kyle’s opinion on ayahuasca as a potential tool for kids [1:31:40];
  
• Relationship with parents, blind spots, compassion, and forgiveness [1:37:15]; and
  
• More.
  

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Show notes page for this episode:peterattiamd.com/kylekingsbury/

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Today's episode of The Qualys is from podcast #26 – AMA #3: supplements, women’s health, patient care, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ 

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In this episode, David Light, CEO of Valisure (the company which alerted the FDA to the Zantac cancer concerns), explains the story behind the recent recalls by manufacturers of ranitidine, a common heartburn medication, sold under the trade name Zantac, due to a potential link to increased cancer risk. David breaks down all the evidence, the role of his unique pharmacy company which tests all its drugs before being dispensed to consumers, and the reason behind the FDA’s tempered reaction to the alarming study results. David makes the argument that Zantac/ranitidine is an inherently unstable molecule which explains the grossly excessive amounts of NDMA (a probable human carcinogen) as opposed to just a contamination for which there could be numerous causes. Finally, David and Peter both provide recommendations for what to do if you or someone you know is currently taking Zantac/ranitidine.

We discuss:

• The impetus for starting Valisure, a unique online pharmacy that tests all its medications [6:45];
  
• The story behind the recall of valsartan, and the role which Valisure played [24:30];
  
• Testing Zantac: The shocking results from Valisure’s initial testing with major potential cancer implications [36:00];
  
• NDMA - the probable human carcinogen found in Zantac/ranitidine [48:45];
  
• The epidemiology question: Are we inferring too much from epidemiology? What can we take away from the existing studies? [53:30];
  
• The staggering results from the 2016 Stanford study, why it didn’t alarm more people, and how Valisure found the missing biological link [1:01:30];
  
• Alerting the FDA, the FDA’s tempered response, and question of contamination vs. inherent instability [1:07:30];
  
• How confident is David that the elevated levels of NDMA being found in ranitidine are not due to instrumentation, human error, or temperature contamination? [1:24:15];
  
• The massive risk being taken by the FDA by not doing more to keep ranitidine away from consumers [1:25:15];
  
• If someone is taking Zantac/ranitidine, what should they do? What else do they need to know? [1:27:45]; and
  
• More.

Learn more: https://peterattiamd.com/

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

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Today's episode of The Qualys is from podcast #15 – Paul Conti, M.D.: trauma, suicide, community, and self-compassion.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ 

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In this episode, Jason Fried, co-founder of Basecamp, shares his beliefs around achieving business success in a modern world which tends to disproportionately focus on the massive success stories (the outliers). Jason gives his honest take on companies like WeWork, Uber, and Lyft that may give off the appearance of wild success but may instead provide an example of the dangers of perverse incentives. We get into Jason’s backstory, and how his affinity for optimizing efficiency and production in the workplace culminated with the creation of Basecamp, his very successful web-based project management software business. Perhaps most importantly, we get really deep into all aspects of work-life balance and what it really means to “work hard” (Stay tuned for an AMA-style deep dive into the topic of work-life balance with Jason in the near future). In addition, Jason provides many more valuable nuggets including thoughts on some common mistakes made by businesses today, the value of giving employees autonomy, how to take the right types of risks, why he doesn’t set any goals, and much, much more.

We discuss:

• Jason’s background and his early entrepreneurial spirit [9:45];
  
• Views on completing higher education and the notion of hard work [24:00];
  
• Beliefs around success in business [35:00];
  
• WeWork, Uber, and Lyft: Poor business practices and the dangers of perverse incentives [41:30];
  
• Jason’s early career: his redesign approach and personal motivation [56:00];
  
• The genesis of Basecamp [1:10:00];
  
• Why Jason does not set goals but instead focuses on a vision [1:12:15];
  
• Workplace motivation and hiring practice [1:20:30];
  
• The importance of luck and not overworking [1:32:00];
  
• A framework to work less and optimize for workplace autonomy [1:38:00];
  
• The importance of saying ‘no’ more often (and tips for doing so) [1:55:00];
  
• A shared passion for watches [2:03:30];
  
• Guarding against the perils of phone addiction [2:08:45];
  
• Jason’s views on email and chat for communication [2:15:00] and;
  
• More.

Learn more: https://peterattiamd.com/

Show notes page for this episode:peterattiamd.com/jasonfried

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Today's episode of The Qualys is from podcast #15 – Paul Conti, M.D.: trauma, suicide, community, and self-compassion.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ 

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In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter’s head of research, asks the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA.

If you’re a subscriber, you can now listen to this full episode on your private RSS feed. You can also watch (or listen) to this full episode on our website at the AMA #9 show notes page.

Questions continue to be pulled from the AMA section on the website, and any subscriber is welcome to submit questions for future AMAs.

We discuss:

• The story of how Peter almost worked for Theranos [2:00];
  
• The trend of lower testosterone and higher estrogen in men: Why is it happening and what to do about it? [10:00];
  
• Takeaways from Peter’s recent hunting trip in Hawaii [14:45];
  
• What books are you currently reading/listening to? [21:30];
  
• What advice would you give to the 25 year-old Peter? [24:00];
  
• What is your emergency protocol if you start getting sick? [27:45];
  
• How have your thoughts changed on NAD precursors, and also on metformin, in the past year or so? [30:30];
  
• What are your thoughts on “fat burning” zones for cardio workouts? — A lesson in relative vs. absolute fat combustion [34:15];
  
• What mental models do you use and how do you go about solving problems and approaching difficult questions? [49:00];
  
• Creatine supplementation—Yay or nay? Why? [49:30]; and
  
• More.

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/ama09/

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Today's episode of The Qualys is a special sneak peek of our yet to be released episode with Paul Grewal.  

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/ 

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In this episode, Dan Harris, correspondent for ABC News and co-founder of the Ten Percent Happier meditation app, speaks openly about his struggles with self-centeredness, addiction, depression, emotional volatility, and the deep-rooted insecurities that drove him to career success. He tells the story of how a panic attack on live TV lead him down a path of self-discovery culminating in a meditation practice which has since transformed his life—in terms of his own personal suffering, his relationships with those closest to him, and his ability to be kind and compassionate (which has its own selfish advantages). Dan also shares some very practical advice and tips for new meditators, dispels some of the myths around meditation, and gives people some things to look forward to as they progress with their practice. Last but not least, we talk about the importance of not passing shame and trauma to our kids and the role that mindfulness and meditation plays in that.

• Dan’s meditation book, and the panic attack on live TV that started it all [8:00];
  
• Addiction: the spectrum of addiction, the socially acceptable forms, and Dan’s own battle with addiction and depression [13:30];
  
• Dan’s drive for self-protection, a defining moment of childhood, and how his upbringing shaped him [20:30];
  
• A selfish reason to be kind and compassionate [28:30];
  
• Using mindfulness to avoid being controlled by your emotions such as anger and grandiosity [36:15];
  
• How Dan found meditation, and how he went from skeptic to someone willing to try it [40:45];
  
• Advice for new meditators, misconceptions about meditation, and the difference between changes in state vs. changes in trait [48:00];
  
• Difference between being “mindful” versus being “present” [55:00];
  
• The overlap between psychology and Buddhism, who is the real Buddha, and a Buddhism 101 lesson [57:45];
  
• What convinced Dan to finally try meditation, and how did his first session go? [1:05:30];
  
• Lessons from Dan’s 10-day silent retreat: “You’re trying too hard” [1:12:30];
  
• How Dan’s meditation has evolved over 10 years of practice [1:27:30];
  
• Dan’s 360 Review: A painful process illuminating his selfishness, and putting him on a path to more kindness and compassion [1:30:45];
  
• How to quiet mental suffering in tough times, and how meditation has helped (and not helped) Dan get through some of the hardest moments of his life [1:41:30];
  
• How Dan’s practice has made him a better husband [1:47:45];
  
• How to prevent the transference of trauma and shame to your kids [1:50:45];
  
• Does past trauma drive successful people? Can a person be successful professionally if they give up that negative insecurity that is driving them? [1:56:00];
  
• The pillars of emotional health, and how to help yourself when you feel insecure [2:08:30];
  
• Why it’s important to let your kids see that you are a flawed human [2:11:30];
  
• Learning from the incredible (but flawed) Peter Jennings [2:15:15];
  
• When is Dan’s next book coming out? [2:21:15]; and
• More.
  

Learn more: https://peterattiamd.com/

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

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Today's episode of The Qualys is from podcast #26 – AMA #3: supplements, women’s health, patient care, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ 

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In this episode, Katherine Eban, investigative journalist and author of Bottle of Lies, illuminates the prevalence of fraud in generic drug manufacturing which brings into question the idea that generics are identical to brand-name drug as we are lead to believe. Katherine walks us through how this widespread corruption came to be, including the shocking story of one particularly egregious (and unfortunately not uncommon) example of an Indian drug company, Ranbaxy, whose business model was completely dependent on falsifying data in their drug applications to the FDA. We then discuss the subsequent investigation into Indian and Chinese drug manufacturing plants which revealed that nearly 80% of them are tainted with fraud. We conclude this discussion on a positive note with i) how individuals can investigate their own drugs to protect themselves ii) an innovative pharmacy attempting to disrupt the market and iii) some ideas on how to reform to the regulations around generic drugs, the FDA, and more.

We discuss:

• How Peter found Katherine’s book, and what convinced her to investigate the generic drug industry [5:45];
• Branded vs. generic drugs: Why they aren’t the same thing [11:15];
• The Food and Drug Administration: Why it was originally created and what it does today [20:45];
• How the generic drug industry really got its start in the U.S., and the flaw of the Hatch-Waxman Act [28:20];
• PEPFAR: How a well-intentioned plan to help Africa with the AIDS epidemic laid the groundwork for corruption [36:30];
• The story of Ranbaxy: An Indian drug company whose business model was fraud and deceit [40:45];
• How the FDA approves drugs, the impact of “first to file”, and Peter’s tangent on moral corruption [47:30];
• A booming generic drug market and the FDA struggling to keep up [57:15];
• Dinesh’s internal investigation finds widespread fraud and falsified data inside Ranbaxy [1:00:15];
• Presenting the famous SAR document to Ranbaxy’s board of directors which spells out the company-wide fraud [1:09:15];
• Dinesh blows the whistle on Ranbaxy which leads to a raid on their US plant [1:19:45];
• Formal investigation of Ranbaxy is launched, but the FDA keeps approving Ranbaxy drug applications [1:33:30];
• What role does the culture in India play in the high prevalence of fraud in the drug industry? [1:41:00];
• The extreme prevalence of data fraud/manipulation in foreign generic drug factories [1:52:30];
• Concluding the Ranbaxy story [2:06:15];
• How concerned should you be when buying a generic drug from your local pharmacy? [2:11:15];
• How to investigate your own drugs for quality to ensure you are getting what you need [2:18:30];
• An innovative pharmacy that tests all its drugs for quality [2:24:45];
• Reforming the FDA and generic drug industry: Why we need reform and ideas on how to do it [2:27:45];
• The importance of taking individual ownership and not waiting for Congress to bail us out [2:34:00];
• Closing thoughts from Katherine [2:36:50]; and
• More.

Learn more: https://peterattiamd.com/

Show notes page for this episode:

https://peterattiamd.com/katherineeban/

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Today's episode of The Qualys is from podcast #18 – Richard Isaacson, M.D.: Alzheimer’s prevention.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ 

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD 

In this episode, David Sinclair, Ph.D., a Professor in the Department of Genetics at Harvard Medical School and co-Director of the Paul F. Glenn Center for the Biological Mechanisms of Aging, returns to the podcast to discuss the content of his new book, Lifespan: Why We Age - and Why We Don’t Have To. This conversation focuses on the biological mechanisms involved in what David terms the Information Theory of Aging which provides insights into the “clock” that determines our aging and to what degree it can be manipulated. Our discussion on aging of course leads us into interconnected topics of epigenetics, sirtuins, cellular senescence, as well as what compounds David is personally taking for his own longevity. Additionally, we discuss the most up to date information related to NAD and longevity by looking at the potential benefits (if any) of supplemental agents (NAD precursors, NR, NMR, etc.) that pose a promise of increasing NAD.

We discuss:

• SIR genes and cellular identity [8:45];
  
• Sirtuins regulate gene expression [14:30];
  
• DNA is methylated at the deepest layer of the epigenome [17:45];
  
• Methylation pattern and determining cellular age [20:15];
  
• Cellular reprogramming [33:45];
  
• Yamanaka factors to push cells "back in time”  [41:00];
  
• Human cellular reprogramming viability [57:00];
  
• Measuring the rate of aging [1:02:45];
  
• Cellular reprogramming for longevity [1:14:45];
  
• Compounds David takes for his own longevity [1:29:15]
  
• NAD precursors (NR, NMN) and pterostilbene [1:40:00];
  
• The current field of sirtuin activators [2:03:15];
  
• David’s artistic work [2:05:15] and;
  
• More.

Learn more: https://peterattiamd.com/

Show notes page for this episode:https://peterattiamd.com/davidsinclair2/

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Today's episode of The Qualys is from podcast #27 – David Sinclair, Ph.D.: Slowing aging – sirtuins, NAD, and the epigenetics of aging.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/  

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In this episode, Dr. Ronesh Sinha, a physician, author, and educator based in Silicon Valley, shares his many insights into metabolic illness that he has gleaned from his South Asian patient population. In this conversation we focus on hyperinsulinemia, insulin resistance, metabolic dysregulation, inflammation, blood pressure, obesity, etc. and ways to address them with nutrition, sleep, exercise, stress management, and more. We also take a deep dive into insulin resistant phenotypes, evolutionary theory and geographic determinants of insulin resistance which provides insight into the genetic architecture and pathophysiology of metabolic syndrome. Additionally, we discuss the surprisingly interrelated topic of stress, and how we might be inadvertently passing this on to our children, leading to mental and physical sickness down the road.

We discuss:

• How a stubborn case of insulin resistance connected Peter with Ronesh [7:15];
  
• Ronesh’s clinical treatment focus of metabolic illnesses in South and East Asian patient populations [8:45];
  
• The distinction between visceral fat and subcutaneous fat stores [15:00];
  
• Shortcomings of a body mass index (BMI) calculator for evaluating metabolic disease risk [17:15];
  
• Cortisol and blood glucose variability [28:30];
  
• Insulin’s role in elevated blood glucose: A symptom of metabolic syndrome [33:25];
  
• Mechanistic explanations of insulin resistance (there may be more than one) [35:15];
  
• Theories on origins and evolutionary reasons for insulin resistance [40:00];
  
• The inverse relationship between the amount of brown adipose tissue and rates of insulin resistance, and the role of climate in patterns and prevalence of insulin resistance [49:50];
  
• Vitamin D levels, hyperinsulinemia, and other effects [53:45];
  
• The evolutionary benefit of being able to turn fructose into fat (and the price we are now paying for it) [58:00];
  
• The VO2 max relationship to insulin resistance and familial metabolic health [59:30];
  
• Using zone 2 fitness test to evaluate mitochondrial performance [1:01:15];
  
• Exercise for long-term functional health [1:06:00];
  
• Lifestyle changes to improve insulin resistance and other metabolic phenotypes [1:14:00];
  
• Is PCOS a manifestation of insulin resistance? [1:21:00];
  
• The impact of stress on adiposity, and Peter’s treatment regimen for overweight females resistant to typical nutritional approaches [1:23:45];
  
• How a culture of achievement and expectations can lead to undue stress, unhappiness, and health problems in our children (a Silicon Valley case study) [1:35:00];
  
• The negative impact of devices and social media on children [1:48:45];
  
• How you can help yourself, your family, and your community without being an MD or PhD [1:55:00]; and
  
• More.

Learn more: https://peterattiamd.com/

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

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Today's episode of The Qualys is from podcast #18 – Richard Isaacson, M.D.: Alzheimer’s prevention.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.