In this episode, originally recorded to be the 100th episode of The Drive, Peter discusses topics that he has changed his mind about since starting the podcast as a result of preparing for interviews as well as from the actual conversations. Peter also reviews some of his favorite moments from the first 99 episodes, shares what books he’s currently reading, and much more. Initially scheduled to be released as episode 100, this was delayed due to recent podcasts covering COVID-19.

We discuss:

• Definition of “strong convictions loosely held,” and the value in trying to shoot down your own hypotheses [2:20];
• Metformin—How Peter’s strong convictions have changed since 2018 [8:00];
  
• Getting a dog—Why Peter caved and how it’s going so far [15:45];
  
• Rapamycin—How Peter’s feelings have evolved, and the questions still needing to be answered [20:45];
  
• Archery, the joy of pursuing mastery, and the importance of stillness [26:50];
  
• Zone 2 training—Why Peter has made it a big component of his exercise regimen [37:30];
  
• Deadlifts—Why Peter now believes it’s extremely beneficial to longevity when done properly [41:45];
  
• Read any good books lately? [50:00];
  
• Baby aspirin for preventing blood clotting—Why Peter no longer takes it, and a few alternative options [53:15];
  
• Generic drugs—How and why Peter’s mind has shifted on generic drugs [55:45];
  
• Omega-3 fatty acids, EPA and DHA—How Peter’s long-held views have changed [58:15];
  
• How Peter got better at saying “no” [1:02:30];
  
• Does Peter have any favorite episodes of The Drive? [1:07:15]; and
  
• More.
  

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/strong-convictions-loosely-held

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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.

Learn more: https://peterattiamd.com/

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

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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.

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/ryanholiday2

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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.

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/samharris2

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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.
    

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/peterhotez-2

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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.

Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/covid-19-update-03152020/

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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.

Learn more: https://peterattiamd.com/

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

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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.

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 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.

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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/  

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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/ 

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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/ 

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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/  

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, 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/ 

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

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/ 

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 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/ 

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

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/

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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/  

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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/  

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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/  

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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/ 

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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.

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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/  

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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/  

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 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/  

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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/  

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, 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.

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, Marty Makary, Johns Hopkins surgeon and NYT bestselling author, discusses his ambitious attempt to fix the broken U.S. healthcare system through educating the public, changing the lexicon, encouraging radical transparency in pricing, and more. We go in detail into the main drivers of inflated health care costs, the money games being played making it hard to understand, and the unfortunate system structure that has resulted in one in five Americans finding themselves in medical debt collections which can ruin the lives of people and families seeking basic medical care. Marty also shares some very practical advice and tips if you find yourself a victim of predatory pricing and stuck with an outrageous medical bill. In the end, despite the current state of the system, Marty discusses the many exciting trends gaining traction in healthcare and why he is very optimistic and hopeful about the future.

We discuss:

• The science of delivering healthcare, how we need to do better as a system, and why no single person or entity fully to blame [10:15];
  
• The stories that prompted Marty to write his first book (Unaccountable) [19:15];
  
• The Surgery Checklist [26:15];
  
• The problem is with the system (not any one person or entity) and the misaligned interests of all the parties involved [28:15];
  
• Patients crave honesty and transparency, and the story of Peter’s back surgery gone wrong [33:00];
  
• Today’s med students and young doctors have less tolerance for predatory pricing and healthcare industry BS [44:30];
  
• Funny stories about John Cameron (legendary surgeon at Johns Hopkins) [48:00];
  
• How doctors are trained to internalize traumatic experiences which can result in a misunderstood form of “burnout” [57:40];
  
• The beat down of med students with traditional medical education and some exciting innovations to medical education [1:07:00];
  
• Exciting trends in healthcare and an optimistic view of the future [1:11:30];
  
• The Price We Pay (Marty’s new book), an attempt to illuminate the blackbox that is the US healthcare system [1:21:00];
  
• Why it’s not always in the best interest of the insurance company to negotiate the best price [1:28:30];
  
• Who is actually paying for medical costs, and Marty’s frustration with the healthcare lexicon [1:32:00];
  
• Pros and cons of a single payer system [1:37:00];
  
• How to fight outrageous medical bills and predatory pricing (and make a dent in the wasteful healthcare spending for the country) [1:49:30];
  
• Disrupting the healthcare industry with private healthcare facilities with market demanded transparency [2:05:45];
  
• The people hurt the worst by the current US healthcare system, the sad breast cancer statistic, and the importance of knowing that medical bills are negotiable [2:09:30];
  
• The healthcare industry bubble [2:14:00];
  
• Increased costs from unnecessary tests and procedures [2:16:30];
  
• Malpractice concerns due to the litigious culture in America: What influence does it have on unnecessary testing, healthcare costs,  and overall quality of treatment  [2:22:00];
  
• Drug pricing, price gouging, middle-men money games, kickbacks, and other drivers of healthcare costs [2:27:45];
  
• How can we possibly fix the healthcare system? [2:34:30];
  
• Helpful resources [2:46:15]; and
  
• More.
  

Learn more: https://peterattiamd.com/

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

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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 “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 #8 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:

• Do DNA kits provide actionable info for cancer, CVD, diabetes, Alzheimer’s, nutrition, or exercise? [1:45];
  
• What genes increase longevity? And do those genes show up on genetic tests like 23andMe? [12:00];
  
• Who are some people that Peter would like to have as guests on The Drive? [15:00];
  
• Inflammation: Is CRP a useful marker? What can one do to reduce it? And what other inflammatory markers can I look at to gauge health? [18:30];
  
• What lipid test does Peter now use on his patients? What are the three best cardiovascular laboratories? [28:00];
  
• Metformin for longevity: What considerations should one think about before doing taking metformin for longevity purposes? [32:30];
  
• What is Peter’s take on salt and its role in things like high blood pressure and stomach cancer? [40:00];
  
• What markers does Peter find most interesting (and surprising) during his quarterly fasts? [47:30]; and
  
• More.

Learn more: https://peterattiamd.com/

Show notes page for this episode:http://peterattiamd.com/ama08

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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.

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, Dr. Vamsi Mootha, an expert in mitochondrial biology and investigator at the Howard Hughes Medical Institute, shares his breadth of knowledge on the mitochondrion organelle: its history, function, genome architecture, and his research of rare mitochondrial dysfunction. Vamsi is currently focused on finding clinical treatments for the 300-some identified rare disorders, but in this work there is a wealth of potential implications in the context of longevity and chronic disease. In this conversation, Vamsi elucidates how the latest research could give insight into conditions related to aging, including but not limited to Alzheimer’s disease, Parkinson’s disease, insulin resistance and type 2 diabetes, cancer, and much more. We also explore some of the most exciting potential therapies for mitochondrial diseases such as hypoxia (oxygen deprivation), how exercise affects the mitochondria, the use of hyperbaric chambers for cancer therapy, and the mechanisms by which Metformin might confer longevity benefits in a non-diabetic individual.

We discuss:

• The Broad Institute of MIT and Harvard [8:00];
  
• Vamsi’s academic background [10:30];
  
• Advice for college students and med students considering a career in medicine and/or medical research [15:30];
  
• Vamsi’s focus on mitochondria and mitochondrial disorders [20:00];
  
• The mitochondrial genome: Lineage, endosymbiosis, and reductive evolution [23:15];
  
• How many diseases can be attributed to mitochondrial mutations? [28:45];
  
• Nuclear DNA and mtDNA: Roles, interaction, communication, and biogenesis [31:30];
  
• Which cells have the most mitochondrial DNA? And how often does mitochondria turn-over in a cell? [37:30];
  
• Does ALL of your mitochondrial DNA come from your mother? [40:00];
  
• Mitochondria 101: The powerhouse of the cell, electron transport chain, and the NADH/NAD ratio [44:00];
  
• NAD and NADH: Role in the mitochondria, decline of NAD levels with age, and what it means to age at a mitochondrial level [51:30];
  
• Mitochondrial diseases Vamsi studies in his lab [55:15];
  
• Mitochondria and oxygen: Poor oxygen utilization and excess oxygen contributes to the pathology seen in some of the rare mitogenic diseases [1:02:00];
  
• What VO2 max can tell us about mitochondrial function, insulin resistance, type 2 diabetes, and more [1:10:00];
  
• Can studying mitochondrial disease provide insights into the common forms of aging?  [1:18:45];
  
• Could muscle cell inflammation (a signature of aging) be caused by mtDNA damage being confused as foreign bacteria? [1:22:00];
  
• Exercise and mitochondrial health: Is there an optimal exercise strategy to slow the aging process? [1:27:00];
  
• What autophagy means in the context of mitochondria [1:36:15];
  
• Metformin’s impact on exercise and lactate levels [1:40:15];
  
• How might metformin confer longevity benefits? [1:48:15];
  
• Hypoxia as a potential therapeutic option for mitochondrial disease [1:52:45];
  
• Cancer prevention and treatment: hyperbaric oxygen chambers, targeting single carbon metabolism of the mitochondria, and more [2:00:00];
  
• Chronic diseases have altered mitochondria: Evidence for mitochondrial dysfunction causing Parkinson’s disease  [2:04:30];
  
• Why Vamsi is very optimistic about the possibility of targeting mitochondrial proteins as therapies [2:09:30];
  
• Is it theoretically possible to genetically engineer a better functioning mitochondria? [2:14:30];
  
• Vamsi’s fantasy experiment in an unconstrained world [2:20:15]; and
  
• More.

Learn more: https://peterattiamd.com/

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

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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/  

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In this episode, Rick Doblin, founder and executive director of MAPS, discusses MDMA, a molecule that has (at a minimum) revolutionary therapeutic benefits for PTSD, but arguably could have, at the highest order, a lasting impact on humanity’s ability to peacefully coexist. Rick details the history of MDMA, what lead to its unfortunate criminalization, and his lifelong work trying to protect MDMA (and other psychedelics) from criminalization (and his subsequent attempt to decriminalize it). Through his founding of MAPS, Rick has made enormous progress in debunking many of the exaggerated risks being claimed against MDMA (neurotoxicity, memory loss, depression, Parkinson’s, etc.), and is very close to getting FDA approval for a psychotherapy technique using MDMA. Additionally, in this discussion, you will learn about the history of LSD, psilocybin, and other psychedelics and how the combination of the misunderstanding of them with the crackdown on drug use in the 1970s lead to their designation of schedule 1 substances. But it’s important to note that you will also realize from this discussion just how different MDMA is compared to the average psychedelic. We end this discussion with a message of hope: there are going to be many people who are going to wonder what can they do to receive this MDMA therapy. We talk about what those clinical trials look like, what the enrollment looks like, and perhaps more importantly, what a compassionate use license would look like, such that if there are patients who are in need of this therapy (prior to its approval) they can have an understanding of the legal paths to doing just that.

We discuss:

• Discovering MDMA, how Rick learned about it and his first experiences with it [9:45];
  
• The timeline of MDMA’s evolution, the reinvention in the 1970s, “ecstasy”, the criminalization of MDMA [21:10];
  
• Explaining the different “schedules” of drugs [30:55];
  
• Rick’s fight to protect it for therapeutic uses, losing to the DEA despite winning in the court, the scientific community, and the media [38:25];
  
• The risks involved with taking MDMA [42:30];
  
• An incredible MDMA-LSD case study: Rick’s story of healing a treatment-resistant PTSD patient in the 1980s [44:45];
  
• How and why MDMA was declared illegal on an emergency basis going against the judge’s recommendation after hearing Rick’s compelling case (and multiple appeals) in court [57:15];
  
• Rick’s decision to study politics to affect change from the inside out, and the recent progress being made with the DEA [1:07:00];
  
• Debunking the exaggerated risks of MDMA (e.g., neurotoxicity) [1:16:30];
  
• Rick’s unbelievable ability to play the long game [1:28:45];
  
• Which patients would not be good candidates for MDMA from a safety perspective? [1:34:30];
  
• How MDMA is different from all other psychedelics, the importance of the setting, and Peter’s experiences with MDMA [1:36:30];
  
• MDMA studies which lead to the crucial designation as a “breakthrough therapy” [1:40:30];
  
• How someone with PTSD can get treated now through “expanded access for compassionate use” [1:46:00];
  
• Rick’s ultimate goal and long term vision for psychedelic clinics [1:50:30];
• Trip of Compassion documentary, and how psychedelics could change the world [1:52:30];
  
• Rick’s early life: Resisting the draft, his feeling of wanting to change the world, and his profound experiences with LSD and other psychedelics [1:55:30];
  
• The history of LSD and psilocybin, and the CIA’s interest in psychedelics [2:10:45];
  
• Timothy Leary and the Good Friday Experiment [2:22:00];
  
• Rick’s follow up study to the Good Friday Experiment, and his criticism (and praise) of Tim Leary [2:33:50];
  
• Peter’s experience taking psilocybin [2:44:30];
  
• The Concord Prison Experiment, and Rick’s follow up study 34 years later [2:47:00]; and
  
• More.
  

Learn more: https://peterattiamd.com/

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

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In this episode, board-certified plastic surgeon, Zol Kryger, enlightens us about the frighteningly loose laws regulating the industry of plastic surgery, paving the way for a majority of cosmetic procedures being performed by doctors that are not board-certified plastic surgeons. We talk about some of the very serious complications that can occur even in “minimally invasive” procedures, where the incidence rate is only increased by the flood of non-certified doctors who want to offer these procedures to augment their income. Fortunately, Zol provides listeners with a very specific list of important questions to ask a surgeon when considering any of the many cosmetic procedures available. We then go into the specifics of the most common procedures and the risk of complications for each of them, including breast augmentation, tummy tucks, liposuction, Brazilian butt lifts, botox and fillers, facial peels and lasers, and more. By the end of this episode, you'll have a really clear understanding of what these risks are and how you can go about reducing those risks by choosing the right physician.

We discuss:

• Why Zol chose plastic surgery [7:30];
  
• The shockingly high percentage of plastic surgery being done by non-board certified doctors, and the laws that allow it to happen [11:20];
  
• 10 Questions to Ask Your Cosmetic Surgeon (PDF Download) [21:00];
  
• Complications: Why you must ask your doctor about potential complications and how they would deal with them [24:20];
  
• Zol’s first complication, how he dealt with it, and how having a partner to check your work is great for the doctor and patient [32:30];
  
• Breast augmentation: What you need to know—types of implants, complication rates, and Zol’s summary of the safest and most effective way to do it [39:10];
  
• Breast reconstruction following a mastectomy [1:06:30];
  
• Tummy tuck: How it’s done, biggest risks involved, scarring, and how it can address hernias and diastasis [1:13:00];
  
• Liposuction: How it works, the potential complications and risks involved, and the importance of choosing the right doctor in the “wild west” of liposuction [1:26:45];
  
• Butt lifts: Rising popularity, major risks, the frighteningly loose laws regulating the industry, and how the butt lift industry is eerily similar to the subprime mortgage crisis [1:37:00];
  
• What is it about plastic surgery (and not other segments of medicine) that compels (and allows for) untrained doctors to offer these procedures? [1:49:45];
  
• Peter asks Zol if he ever feels emotionally conflicted working in an industry that sometimes can feed off the vanity and insecurity of people [1:56:25];
  
• Does Zol ever turn down patients? [2:02:45];
  
• The risks involved with botox, fillers, facial peels, and laser treatments [2:07:45]; and
  
• More.
  

Learn more: https://peterattiamd.com/

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

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We discuss:

• What can I do to prevent/reduce interruptions in sleep due to needing to get up to urinate at night? [3:00];
• Peter’s note card system for organizing his to-do lists [7:15];
• How do I get smarter at reading/understanding the studies (or the media's interpretation of them) that get the headlines on health and/or disease? [11:15];
• How can I obtain a continuous glucose monitor (CGM) as a non-diabetic individual? [11:55];
• What is the most effective way to bring blood pressure down? [15:00];
• Does Peter use any nootropics? [28:10];
• Peter’s thoughts pertaining to concussions and head trauma [33:00];
• Does Peter structure his exercise plan for lifespan or healthspan? [36:45];
• How did Peter rebuild his lower back strength after his devastating injury during med school? [38:15];
• Peter’s approach to deadlifting with a bad lower back [43:25];
• Did Peter cave and buy a dog? [51:50]; and
• More.

Learn more at www.PeterAttiaMD.com
Connect with Peter on Facebook | Twitter | Instagram.

In this episode, Keith Flaherty, director of clinical research and targeted cancer therapy at Massachusetts General Hospital, shares his vast wealth of knowledge in cancer starting with the history of treatment from chemotherapy to radiation to surgical therapy and where those methodologies seemed to have leveled off. He also walks us through the timeline of advancements (and lack there of) from when the War on Cancer was declared in the 1970s, through the sequencing of the entire human genome, and all the way to today. Keith dives into the topic of immunotherapy, probably the most exciting recent development in cancer therapy, and also provides us a rundown of his notion of a different approach to cancer that attacks all the essential pillars of cancer growth and survival. Finally, we talk a little bit about liquid biopsies, we discuss the roles of CRISPR and other potentially over-hyped therapies with respect to cancer. We also touch on stem cell therapy a bit, as well as some other common cancer-related questions such as the role of vitamin D and sun exposure in melanoma, and much more.

We discuss:

• Growing up around medicine, and finding a career that you love [7:30];
• Medicine as a career, limitations of the med school teaching approach, and the dynamic and accelerating field of medicine and technology [16:30];
• Explaining chemotherapy, radiation, and how a cancer develops [23:45];
• Surgical oncology, cure rate of solid tumors, and survival rate after tumor removal  [33:15];
• 25 years after the War on Cancer is declared, gene sequencing, and why Keith’s was fascinated by the HIV case study [37:15];
• Cancer immunotherapy: History, how it works, and why some cancers respond and others don’t [46:00];
• MHC complexes, and cancer cloaking mechanisms [56:00];
• Comparative biology of cancer: Why some cancer can evade immune detection better than others [1:03:00];
• What we learned from the Cancer Genome Atlas Project [1:07:00];
• Defining targeted therapy, HER2 breast cancer, chronic leukemia, and the translocation of chromosomes [1:12:00];
• Tumor protein P53, the most famous tumor suppressor gene and its ubiquity in cancer [1:17:45];
• Activated oncogenes, the RAS pathway, PI3 kinase, RAF gene, and Keith’s “aha moment” [1:24:15];
• Advice for starting your career as a scientist/clinician [1:37:00];
• Fusion-driven cancers, targeted therapy, and the Bcr-Abl/chronic myelogenous leukemia case study [1:39:45];
• Targeted therapy for fusion-driven solid tumors, adjuvant systemic therapy, and the HER2 breast cancer example [1:53:00];
• Advancing melanoma treatment, survival, and cure rates with BRAF-MEK combo therapy [1:59:15];
• The fundamental pillars of cancer growth and survival, and the toolkit we need to attack cancer from all angles [2:02:40];
• Peter’s clinical framework for thinking about cancer and how Keith might improve it, and how the biotech environment is hampering our ability to put together novel cancer treatments [2:05:00];
• How useful is CRISPR in terms of tumor suppressing? [2:16:15];
• Liquid biopsies as a therapeutic monitoring tool [2:18:00];
• Stem cell therapy: The efficacy and potential risks [2:25:15];
• Aging and cancer: Is cancer inevitable? [2:28:45];
• Vitamin D supplements, sun exposure, melanoma, and exercise [2:32:30];
• How and why Keith has straddled the line between science/research and industry/drug companies, and the importance of getting more voices of practitioners at the table [2:42:00]; and
• More.

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In this episode, radiologist/engineer, Raj Attariwala, explains how he was able to apply his engineering background to create a unique MRI scanner that is capable of constructing whole-body images with a resolution that is unmatched in the industry. Peter and Raj discuss the implications of such a robust, radiation-free imaging tool on the early detection of cancer. They dive deep into cancer screening and define terms such as sensitivity and specificity that are necessary to really understand this complex space. They then describe the biggest risks involved in this type of screening (false positives) and how Raj’s unique technology and process might drive down this risk substantially. But before that, they discuss all the common imaging technology from X-ray, to CT scan, to PET scans, to ultrasound, to MRI, and more. They touch on the history of each, how they work, the usefulness and limitations of each of them, as well as the varying risks involved such as radiation exposure. If you are interested in cancer screening and/or you’ve ever wondered how any radiology tool works, this episode is for you.

We discuss:

• Raj’s road from engineering to radiology [7:45];
• How X-ray works, the risk of radiation exposure, and the varying amounts of radiation associated with the different imaging technologies [18:00];
• Computed tomography scans (CT scans): The history of CT, how it works, and why we use contrast [27:45];
• Ultrasound: Benefits and limitations, and a special use for the heart [40:45];
• Detecting breast cancer with mammography: When is works, when you need more testing, and defining ‘sensitivity’ and ‘specificity’ [51:15];
• Magnetic resonance imaging (MRI): How it works, defining terms, and looking at the most common types of MRI [1:03:45];
• Brain aneurysms: Using MRI to find them and save lives [1:23:45];
• Raj’s unique MRI technology [1:30:00];
• The risk of false positives in cancer detection, and how Raj’s MRI can reduce the number of false positives (i.e., increase specificity) [1:43:40];
• The unique software Raj created to pair with his MRI machine [1:51:15];
• Comparing the radiation exposure of a whole-body PET-CT to Raj’s equipment (DWIBS-MRI) [1:53:40];
• How diffusion-weighted magnetic resonance imaging (DW-MRI) has revolutionized cancer screening [1:55:15];
• Why a DW-MRI is still not a perfect test [1:59:00];
• The potential for advancing MRI technology: Where does Raj think it could improve in the next 5-10 years? [2:03:00];
• Are there any commercially available scanners that can match the resolution of Raj’s images? [2:06:00];
• Machine learning: When and where might machine learning/AI impact the field of radiology? [2:08:40]; and
• More.

Learn more at www.PeterAttiaMD.com
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In this anniversary episode, Olivia, Peter's daughter who initially kicked off The Drive podcast with her sneak peek episode, returns to ask Peter the tough questions on how the podcast is going, what he has learned along the way (and how he plans to make it better), what exciting things are in store for the future, and plenty more.

In this episode, former World Series of Poker champion and author, Annie Duke, explains how poker is a pertinent model system for decision making in the real world, a system which blends imperfect information with some unknown percentage of both luck and skill. We go through the decision-making matrix, and how we spend most of our energy focusing on just one of the four quadrants at the expense of the learning opportunities that come from the other 75% of situations. Annie also shares how this evaluation of only the bad outcomes (and our tendency to judge others more harshly than ourselves in the face of a non-status quo decision), leads individuals, leaders, and teams to avoid bad outcomes at all costs. This avoidance is at the cost of the types of decisions which lead to progress and innovation both personally, and societally, across many realms from poker to sports to business to medicine. We also dive deep into a framework for learning, and the levels of thought required to rise to the top of a given domain. Finally, we talk about something that resonated deeply with me in terms of how I think about extending healthspan, which is the concept of “backcasting”.

We discuss:

• Matthew’s TED Talk, and his favorite public speakers [7:45];  
• How good are the current sleep trackers like Oura, Fitbit, etc.? [10:45];
• Is it bad to eat food too close to bedtime? [15:30];
• How does exercise impact sleep? [17:30];
• How is appetite affected by our sleep quality? [21:30];
• Anxiety, cortisol, and weight gain: An awful feedback loop of sleep deprivation [23:30];
• How to optimize your wind down routine: lights, temperature, & relaxation [26:10];
• How alcohol disrupts sleep (and contributes to Alzheimer’s disease) [46:00];
• Sleep’s impact on sex hormones, and romantic relationships [50:00];
• Performance, accuracy, and minimizing the damage of shift work [55:30];
• Bed partners: How to sleep in separate beds and retain a good relationship [59:30];
• Can we use sound machines and electrical stimulation to improve sleep? [1:02:40];
• Will we ever be able to “supercharge” our sleep stages using technology? [1:08:30];
• Why sleep is the best insurance policy for lifespan and healthspan [1:11:45];
• Melatonin: How (and how not) to use it for sleep improvement [1:19:00];
• The dangers of sleeping pills, useful alternatives, and cognitive behavioral therapy for insomnia [1:28:30];
• Can CBD and THC be used for sleep? [1:43:30];
• Why haven’t we been able to develop a really effective sleeping aid? [1:50:40];
• Can you get too much sleep? [1:55:50];
• What to do (and not do) immediately following a terrible night of sleep? [2:09:15];
• Why a consistent wake up time is king [2:14:30];
• Does poor sleep speed up the aging process? [2:16:00];
• Can different people be more (or less) resilient to sleep deprivation? [2:22:50];
• Finding your optimal sleep schedule and determining your sleep chronotype [2:27:45];
• Defining sleep efficiency and how to improve it [2:33:25];
• Correcting insomnia: A counterintuitive approach [2:35:45];
• How can parents improve the sleep of their kids? [2:41:30]; and
• More.

Learn more at www.PeterAttiaMD.com
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In this episode, Rick Rubin, legendary music producer and co-founder of Def Jam Records and American Recordings, discusses his early foray into music production which started as a hobby as a teenager and ultimately turned into a Grammy award-winning career that produced revolutionary changes in the music industry. Rick has worked with the likes of the Beastie Boys, Red Hot Chili Peppers, and Johnny Cash, just to name a small fraction. Rick talks about the pain and suffering that sometimes drives music and the cycle of drug addiction and how he has been able to help artists through those struggles to make space for their creative genius. We also get into Rick’s own personal health journey including his battle with depression, his struggle with obesity, and ultimately his extraordinary transformation. Finally, Rick shares a really significant health scare which required emergency heart surgery, and how that experience has impacted him.

We discuss:

• Early career, and the birth of hip hop [7:15];
• Early success of Def Jam Recordings, and working with LL Cool J [13:15];
• Revolutionary changes in music: LL Cool J, Beastie Boys, and Run DMC [19:30];
• Partnership with Columbia Records, and leaving Def Jam [26:45];
• The success of Licensed to Ill: how it took off, and how it changed things [36:00];
• American Recordings: Rick’s transition to rock and roll [39:15];
• Working with the Red Hot Chili Peppers, and the poetic nature of music [45:45];
• Rick’s favorite music that he did NOT produce [53:00];
• Prevalence of drug use and emotional pain in musicians: Rick’s experience with helping artists through their struggles [57:20];
• NYC vs. LA hip hop [1:05:30];
• Rick’s battle with depression [1:10:00];
• Coping with the death of artists that Rick worked with [1:22:00];
• Working with Johnny Cash [1:26:45];
• Working with Rage Against the Machine [1:34:30];
• The digital age of music: Have we lost something? [1:37:45];
• Rick’s health journey and battle with obesity [1:42:45];
• Radical weight loss: How Rick was finally able to shed the weight [2:00:15];
• Total transformation: Exercise and training with Laird Hamilton [2:11:00];
• Emergency surgery: Rick’s frightening heart condition [2:25:30];
• Methylene blue and exogenous ketones: Are they neuroprotective? [2:46:15];
• The most profound thing Rick learned about himself from his heart condition and major surgery? [2:52:30];
• What life lessons does Rick wish to impart on his son? [2:57:30]; and
• More.

Learn more at www.PeterAttiaMD.com
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In the second installment of this 2 part series, Jocko shares his sleep routine and attitude towards sleep, we talk about his meals (and occasional indulgences), his experience with fasting, and touch briefly on his workout routine. Jocko explains his approach to leading a family, instilling values in his kids, and working with others who may not share your same principles. We also find out what prompted Jocko to make discipline the underpinning principle of his life, when it might make sense to quit, and the philosophical topics such as free will, mindset, and whether or not you can change someone. We also discuss 9/11 and the war in Iraq and Afghanistan, the future of warfare, and perhaps more importantly, how Jocko’s experience in combat has shaped and impacted his life to this day.

We discuss:

• Where was Jocko when the 9/11 attack occurred? What did he think? [5:45];
• How SEAL teams are structured, and which teams Jocko was on [10:45];
• War in Afghanistan: Unique challenges, how it differs from Iraq, and the lessons learned [13:00];
• Iraq War: Differing public opinions on war, Jocko’s experiences in Iraq, strategic mistake of ISIS, and the Saddam regime [19:15];
• The future of warfare: machine technology in war and medicine [27:30];
• Raising kids, instilling values, and leading a family [33:45];
• Sleep: Jocko’s habits, routine, and attitude towards sleep [40:15];
• When it makes sense to quit [53:30];
• What makes Jocko different, the existence of free will, and whether or not you can change people [1:01:45];
• How to work with people with a bad attitude and opposing mindset [1:07:45];
• Does Jocko ever indulge? Favorite foods and treats [1:11:00];
• Fasting and meal timing [1:16:30];
• Olivia (Peter’s daughter) interviews Jocko [1:21:45];
• What prompted Jocko to start prioritizing discipline in his life? [1:22:15];
• What does Jocko do in his workouts? [1:23:30];
• Where did the nickname, Jocko, come from? [1:24:20];
• Jocko’s favorite book, his best advice, and secret to getting up early [1:25:50];
• The impact that war had on Jocko [1:28:00]; and
• More.

Learn more at www.PeterAttiaMD.com
Connect with Peter on Facebook | Twitter | Instagram.

In part 1 of this 2 part series, Jocko Willink, retired Navy SEAL, discusses some of his most important lessons learned from his time commanding some of the world’s most expert special forces operators including the importance of understanding the objective and strategy (and then tactics) of a mission, why humility is the greatest trait a leader can have (and certain times when it’s not), as well as the necessity of having proper protocols in place to deal with whatever comes your way. We also talk about how Jocko prioritizes his military and family obligations with his love for jiu-jitsu, as well as how to decipher what really matters in life. Finally, we go through the US history with respect to various wars from World War I, all the way forward, and much much more. 

We discuss:

• Objective, strategy, and tactics [6:00];
• Training compared to actual combat [20:30];
• The importance of humility in leadership, business, and life [33:00];
• The dichotomy of human traits: Can you be too humble? [49:00];
• Why many leaders lack humility [52:30];
• Why Jocko wanted to be a Navy SEAL [55:00];
• Jocko’s attitude toward death, and dealing with the death of a soldier [58:45];
• The vital importance of protocols [1:03:45];
• Protocol for losing a child (or anyone close to you) [1:15:00];
• Protocol for getting dumped, and some relationship advice [1:18:00];
• How to differentiate between things that matter and things that don’t [1:24:30];
• Jocko shares his experience during BUD/S [1:35:45];
• How Jocko prioritizes his family and SEALs obligations: Would Jocko come out of retirement and go back to war? [1:48:30];
• America’s lost sense of connectedness and purpose since WWII [1:59:00];
• How warfare has evolved over the decades since WWI [2:05:40];
• Obeying orders and the obligation to dissent [2:09:00];
• WWI and WWII, the beginnings of “decentralized command” [2:15:00];
• The American warrior mentality, and the impact of freedom on a society [2:20:45];
• What impact can an individual president really have? [2:25:00];
• The Korean war [2:29:15];
• Lessons learned from Vietnam [2:31:10];
• First Gulf War, Iraq War, and The War in Afghanistan [2:35:45]; and
• More.

Learn more at www.PeterAttiaMD.com
Connect with Peter on Facebook | Twitter | Instagram.

In part 1 of this 2 part series, Jocko Willink, retired Navy SEAL, discusses some of his most important lessons learned from his time commanding some of the world’s most expert special forces operators including the importance of understanding the objective and strategy (and then tactics) of a mission, why humility is the greatest trait a leader can have (and certain times when it’s not), as well as the necessity of having proper protocols in place to deal with whatever comes your way. We also talk about how Jocko prioritizes his military and family obligations with his love for jiu-jitsu, as well as how to decipher what really matters in life. Finally, we go through the US history with respect to various wars from World War I, all the way forward, and much much more.

In this episode, Kevin Sayer, CEO of Dexcom, discusses the remarkable benefits of a continuous glucose monitor for the diabetes population. Peter shares his own invaluable insights he’s learned from wearing a CGM including the impact of sleep and stress on glucose as well as the unmatched power of a CGM to drive behavioral change. Kevin also reveals some of the exciting partnerships and future advancements of their products benefiting not only those with type 1 and 2 diabetes, but also for the growing community of people interested in optimizing health and wellness.

We discuss:

• How they met, and Kevin’s path to becoming CEO of Dexcom [7:00];
• How CGM technology works, and what makes Dexcom’s G6 the best model yet [15:15];
• Challenges of working in the US healthcare system and getting CGM insured [21:45];
• Developing an even smaller, more user-friendly, and less costly product while maintaining performance and accuracy [33:15];
• Next thing on the horizon for type 1 diabetes patients [43:30];
• The incredible accuracy of the G6, recommended over-the-counter glucose meters, and the unmatched power of CGM to drive behavioral change [48:15];
• Software improvements for type 2 diabetics, and the remarkable benefits of real-time feedback for driving behavioral change [58:15];
• Dexcom vs. the competitors, the less invasive options, and the fundamental problems needing to be solved with CGM technologies [1:07:00];
• The cost of CGM, why you need a prescription, and when might there be a OTC option? [1:12:00];
• Smartwatch integration, bluetooth technology, and exciting collaborations and partnerships [1:22:00];
• Future places for CGM: Hospitals, nutrition apps, general health and wellness, and more [1:27:15];
• Dexcom’s unique company culture [1:34:15];
• Parenting advice from Kevin [1:37:30];
• Lessons learned through failures and success [1:38:45]; and
• More.

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In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter’s head of research, asks the questions. If you’re listening on a podcast player, you’ll be able to hear a preview of the AMA.

If you’re a subscriber, you can watch or listen to this full episode on our website at the AMA #6 show notes page. 

PLEASE NOTE: We are currently building a private RSS feed that will allow subscribers to listen uninterrupted on the podcast player of their choice. This will be released shortly.

Questions are pulled from the AMA section on the website (peterattiamd.com). Any subscriber is welcome to submit questions.

We discuss:

• Vitamin supplementation: Is it necessary if you eat a balanced diet? [2:00];
• Antioxidants: What does current science have to say about antioxidants in food and supplements? [9:00];
• How do you break a fast of more than three days? [17:15];
• Does a morning black coffee break a fast? In other words, does black coffee raise insulin levels? [22:15];
• When intermittent fasting, does the placement of the “feeding window” matter? [25:30];
• Is it better to fast before or after a planned food binge (e.g., Thanksgiving)? [28:30];
• Fasting protocol: Do you have a specific protocol to recommend? [31:30];
• Time management: How do you manage your time between work, family, and your many personal interests? [35:45];
• Problem solving: Can you breakdown your process of problem-solving? [46:45];
• For those looking to gain a better understanding of biochemistry, pharmacology, etc., do you have any good textbooks or (online) resources to recommend? [49:00];
• What are some of your favorite podcasts that you listen to? [51:15];
• What is your favorite animal? [54:45]; and
• More.

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In this episode, Ethan Weiss, Hopkins trained preventative cardiologist at UCSF, discusses two topics that on the surface may seem unrelated which is cardiovascular disease, and the role of growth hormone and IGF in disease. Ethan provides a masterclass in everything from acute coronary syndrome to all of the complex nuances around stent placement, as well as how calcium scores and results from CT angiograms shape his treatment of patients. He also shares how his idea to study the sex differences in blood clotting as it relates to coronary disease lead him to pursue the field of endocrinology, and specifically what he found with respect to the effect of growth hormone and IGF on the liver, the brain, and overall human longevity. 

We discuss:

• Mutual love for hockey [7:15];
• Ethan’s background and interest in cardiology [13:15];
• Clinical definitions of a heart attack, clotting, and plaque: What causes the acute event? [24:15];
• Defining coronary disease and myocardial infarction: The evolving nomenclature [32:00]; 
• What happens when someone comes to the ER with a STEMI (ST elevation myocardial infarction)? [47:15];
• Stents [54:45];
• Treatment protocol for both acute and chronic coronary artery disease: History, controversy, and important distinctions [1:06:30];
• Using stents to treat stable angina: What we learned from the COURAGE AND ORBITA trials [1:15:30];
• The “art” of longevity: The challenge of preventative medicine and understanding risk [1:31:45];
• Understanding CAC scores, and CT angiogram results [1:40:15];
• How sex differences in clotting and heart disease got Ethan interested in growth hormone and IGF [2:01:00];
• Impact of growth hormone on the liver [2:07:00];
• Growth hormone and insulin sensitivity [2:18:00];
• The role of GH and IGF on chronic disease and cancer [2:23:30];
• Will taking growth hormone promote longevity? [2:32:30];
• GH and IGF as a treatment for early stage dementia? [2:34:30];
• What happens to IGF while fasting and what about fasting improves longevity?  [2:35:15];
• The importance of becoming scientifically literate and making science more exciting for future generations [2:38:30];
• Ethan’s new company: Keyto [2:43:45]; and
• More.

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To celebrate the life of the legendary Formula 1 driver Ayrton Senna, 25 years to the day of his tragic death, we are re-releasing this bonus episode. In this episode, Peter and med school colleague (and brilliant psychiatrist) Paul Conti reminisce on their favorite moments in Formula 1 history, their deep admiration for the late Ayrton Senna, and the remarkable careers of their favorite drivers. Paul also helps to illuminate the psychological components that made the luminary drivers great, and the cautionary lessons we can take from their incredible lives.

We discuss:

• Who is Ayrton Senna? [3:47];
• How Senna’s death changed the sport [9:52];
• The 80s & 90s: a remarkable era of Formula 1 [12:57];
• Hypothesizing what caused Senna’s fatal crash [17:47];
• Comparing Stewart and Senna, their incredible bravery, and what lessons we can learn from them [23:32];
• Best documentaries on racing, and some of Senna’s best moments [31:02];
• Gilles Villeneuve, Stefan Bellof, and some of the other greats [39:17];
• Why Senna is widely acknowledged as the best of all time [46:17];
• Great rivalries and personalities [49:32];
• Rendezvous, a high-speed drive through Paris [56:52]; and
• More.

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In this episode, Robert Sapolsky, Ph.D., discusses the widespread impact of stress on our physical and emotional health as well as the mechanisms by which it can precipitate chronic illness, dementia, depression, and more. He also provides insight into the factors that contribute to the stress response (and our ability to handle it) such as social rank, personality, environment, and genetics. Lastly, we discuss how our behavior is altered in the face of stress and how that not only has a pervasive effect on a personal level, but also on society as a whole in how we interact with each other. 

We discuss:

• Background, interest in stress, and Robert’s time in Kenya studying baboons [7:00];
• Physiology of a stress response, and why it’s ingrained in our DNA [14:00];
• Individual variation in the response to stress, and how everyone has a different optimal level [24:00];
• How social rank and personality differences affect our stress response [30:15];
• What’s happening in the brain when faced with stressful situations? [39:15];
• What makes the human brain different than all other species? [48:15];
• Imprinting stress to your kids epigenetically [52:00];
• The role of stress on memory and the consequences of hypercortisolemia [57:15];
• The impact of subjective socioeconomic status and social media on stress levels and health [1:01:45];
• Tips for managing stress in the modern world [1:17:45];
• What Robert learned about himself studying the social behavior of baboons [1:29:30];
• The multilayered factors behind every human behavior, the context of “good and bad,” and exploring the human capacity of the wild extremes of violence and altruism from moment to moment [1:34:30];
• PMS: How two women with identical hormone levels can have completely different emotional experiences [1:39:00];
• How much of a role do genes play in depression and other emotional states? [1:42:45];
• Why is cortisol elevated under sleep deprivation? [1:50:15];
• The impact of stress on cancer [1:54:30];
• The impact of stress on atherosclerosis, dementia, addiction, and depression [2:01:15];
• Impulsiveness, impaired judgement, and lack of empathy in times of stress [2:05:45];
• What advice would Robert give his 25-year-old self? [2:12:45]; and
• More.

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In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter’s head of research, asks the questions. If you’re listening on a podcast player, you’ll be able to hear a preview of the AMA.

If you’re a subscriber, you can watch or listen to this full episode on our website at the AMA #5 show note’s page.

PLEASE NOTE: We are currently building a private RSS feed that will allow subscribers to listen uninterrupted on the podcast player of their choice. This will be released shortly.

Questions are pulled from the AMA section on the website (peterattiamd.com). Any subscriber is welcome to submit questions.

We discuss:

• Coronary calcium score: what it means and how to interpret your results [1:15];
• How to train for the “centenarian olympics” [18:00];
• Explaining the blood glucose response to various types of exercise [35:30];
• The Tabata protocol [43:15];
• Exercising on a ketogenic (or low-carb) diet: performance, muscle glycogen, adaptation, and more [49:30];
• The work of Dr. Gabor Maté and its impact on Peter [54:15];
• What's the best book you've read in the past year? [55:45];
• What is “pattycakes?” [59:00];
• What is the latest and greatest of egg boxing [59:30]; and
• More.

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In the final part of this 3 part series, Matthew Walker, professor of neuroscience at UC Berkeley and expert on sleep, discusses the omnipresent effects of insufficient sleep on everything from metabolism, appetite, athletic performance, decision-making, productivity, leadership, mental health, genetics, memory, and more. We also discuss the impact of caffeine and alcohol on sleep quality, the efficacy of sleep aids such as THC and CBD, and much more.

We discuss:

• Sleep and insulin resistance [6:15];
• Epigenetic changes with insufficient sleep, and the reversibility of lost sleep [18:00];
• Sleep’s impact on exercise performance, appetite, and food choices [28:15];
• Decision making, workplace production, leadership qualities, physical attractiveness, and more [43:15];
• The broken water pipe analogy [49:30];
• The negative effect of caffeine, alcohol, and high carb meals on sleep quality [53:30];
• The efficacy of THC and CBD as sleep aids [1:05:30];
• Sleep and mental health: A two-way street [1:16:45];
• How sleep impacts memory, and Matthew’s current and upcoming projects [1:24:00];
• Sleep’s impact on athletes: Looking at Formula One drivers [1:32:45]
• Translating the science to clinical application [1:57:00]; and
• More.

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In part 2 of this 3 part series, Matthew Walker, professor of neuroscience at UC Berkeley and expert on sleep, describes the preponderance of evidence linking poor sleep to cardiovascular disease, cancer, and sexual function. He also details the impact of cortisol on our nervous system contributing to sleep disturbances and insomnia as well as the efficacy and risks associated with the most common sleeping pills. Matthew also describes the sleep needs of teenagers and urgently lays the case that we should reconsider school start times. We also get into the effect of electronics at night, the efficacy of napping, the general impact of modern society on our sleep habits, and what changes we can make to course correct. 

We discuss:

• Sleep and cardiovascular disease [6:00];
• Fuel partitioning and dieting while sleep deprived [16:45];
• Sleep and the reproductive function: testosterone, sperm count, FSH, menstrual cycles, and fertility [19:45];
• The biological necessity of sleep, the lack of a “safety net”, sleep debt, and ways to course correct sleep problems [23:45];
• Fighting cancer and improving immune function with sleep [34:30];
• The medical profession: A culture that devalues sleep [47:30];
• The sleep needs of children, the travesty of early school start times, electronics at night, and advice for parents [1:04:45];
• How exposure to light affects sleep, and how modern society has changed our sleep habits  [1:26:15];
• Is napping helpful? [1:36:00];
• The effect of cortisol levels on sleep [1:41:15];
• Are sleeping pills doing more harm than good? [1:52:15]; and
• More.

Learn more at www.PeterAttiaMD.com
Connect with Peter on Facebook | Twitter | Instagram.

In part 1 of this 3 part series, Matthew Walker, professor of neuroscience at UC Berkeley and expert on sleep, describes the different stages and cycles of sleep, including what he calls the 4 pillars of sleep, and how they contribute to memory consolidation and numerous important pathways to mental health. We also get into the dangers of chronic sleep deprivation, such as the development of dementia, and the more acute dangers of sleep deprivation like fatal car crashes which are most often caused by drowsy driving. We also discuss the different and important roles of REM vs. non-REM sleep, and the impact that bad sleep habits can have specifically on those sleep stages. 

We discuss:

• Matthew’s background and interest in sleep [6:03];

• Sleep and Alzheimer’s disease, and the 4 pillars of sleep [12:18];

• Stages of sleep, sleep cycles, and brain waves [41:18];

• Memory and sleep, and the risk of insufficient REM sleep [55:48];

• Evolutionary reasons to sleep [1:02:03];

• The early riser vs. the night owl, and tips for overcoming jet lag [1:10:18];

• Is there one type or stage of sleep that is most important? [1:17:33];

• The dangers of drowsy driving [1:28:48];

• The timeliness of Matthew’s book, and how the conversation of sleep has changed over the past several years [1:35:18]; and

• More.

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In this episode, Chris Masterjohn, entrepreneur, independent researcher, and doctorate in nutrition, elucidates the latest research on the risk and benefits of NAD supplements, and shares his personal intuition on the topic. We also dive deep into choline deficiency and its role in the rising prevalence of nonalcoholic fatty liver disease. From there, Chris enlightens us on the importance of methylation, a simple yet profoundly important biochemical process affecting our physical and mental health. He also describes the variations of the genes MTHFR and COMT, enzymes which play important roles in methylation and which have profound impacts on our well-being.

We discuss:

• Chris’s background, falling in love with biochemistry, and decision to pursue research over medicine [7:45];
• Choline: what it is, why it is important, and how a deficiency can cause non-alcoholic fatty liver disease [11:45];
• NAFLD: increasing prevalence and potential causes [25:00];
• TMAO: Should we be worried about the TMAO content in choline and our foods? [39:15];
• Types of fatty acids: How they may predispose us to different types of illnesses [53:30];
• Why don’t we see low VLDL in patients with NAFLD? [59:45];
• Understanding flux, and how machine learning may affect medicine in the near future [1:03:15];
• NAD: How it works, supplements, sirtuins, and the central role of the liver [1:09:30];
• Intravenous NAD [1:33:00];
• Oral NR: Is it the optimal way to get more NAD? [1:38:30];
• What is the possible harm of taking an NAD precursor? [1:47:15];
• The MTHFR gene [1:49:45];
• The methylation pathway [1:58:15];
• The COMT gene [2:04:30];
• Creatine: The uses and benefits and its important role in methylation [2:10:15];
• Dietary strategies for MTHFR: choline, creatine, folate, and glycine [2:16:45];
• How to mitigate the negative effects of NAD supplements [2:23:45];
• A case study of a person with high homocysteine [2:28:00];
• What is the level of evidence that you need to take action? [2:32:15];
• Does Chris supplement with NAD precursors? And can it improve symptoms of rosacea? [2:35:45];
• Decision making in the face of inconclusive data, and trying to disentangle the placebo effect [2:39:00];
• What does Chris believe to be true that very few people would agree with him about? [2:43:15];
• How to follow Chris’s work [2:48:45]; and
• More.

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Connect with Peter on Facebook | Twitter | Instagram.

• Blue light blockers and how they improve sleep [1:30];
• How to minimize jet lag and sleep disruption while traveling [6:45];
• How to treat symptoms of PMS, the female hormone cycle, testosterone in women, and estrogen in men [15:45];
• Autophagy: what it is, why it matters, and how can we enhance it [26:15];
• The two-minute drill (and a bonus Patriots and Tom Brady tangent) [41:15];
• Has Peter thought about having CME accredited content for people in the medical field? [44:15];
• How does one find good doctors that are somewhat up to date on the latest research, primary care, etc.? [45:45];
• What values would Peter be interested in monitoring continuously if the tech existed? [47:15];
• How to annoy Peter [49:15];
• If I'm interested in longevity, should I do a Ph.D. or M.D.? [50:00]; and
• More.

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In this episode, Jeremy Schaap, preeminent journalist at ESPN, discusses two of the most incredible upsets in boxing history, both of which Jeremy has expertly covered during his illustrious career, most recently culminating in the 30 for 30 special, 42 to 1. We also discuss his infamous Bobby Knight interview, his coverage of the doping scandals in baseball and cycling, as well as the pressures of following in his father’s enormous footsteps who taught him the importance of fairness in journalism. Additionally, we discuss the deeper meaning of sports, what it teaches us, and how he uses sports as a platform to bring light to greater societal issues. 

We discuss:

• Jeremy and Peter’s shared obsession with boxing history [5:15];
• Cinderella Man: The incredible upset of Max Baer by James Braddock, and the rise of the great Joe Louis [9:00];
• 42 to 1: Buster Douglas beats Mike Tyson for one of the most unlikely upsets in the history of sports [23:30];
• Contrasting fighting styles from “destroyers” to “artists”, and comparing the auras of the all-time greats [36:30];
• Mike Tyson’s take on the Douglas fight, what went wrong for Buster Douglas following his victory, and other incredible upsets in sports history [45:30];
• Ranking the greatest boxers since the 1960s [54:00];
• Jeremy’s famous Bobby Knight interview: A career defining moment [57:00];
• The pressures of following his father’s career path, and what it means to be a fair journalist [1:01:30];
• The meaning of sports: how it brings us together and gives us a platform for bigger discussions [1:11:00];
• Jeremy’s biggest regret in reporting, the 1998 home run chase, and the doping scandals of baseball and cycling [1:17:30];
• The biggest and most underreported stories in sports [1:26:45];
• Best 30 for 30 episodes: Jeremy and Peter pick their favorites [1:31:30];
• Baseball: Steroids and the hall of fame [1:34:30];
• Final thoughts on what makes sports so special [1:37:45]; and
• More.

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In this episode, Alan Bauman, certified hair transplantation surgeon and hair restoration expert, discusses both male and female pattern hair loss, the science behind what drives it, and what that tells us about prevention and restoration. Having treated over 20,000 patients, Alan shares his invaluable insights into what works and what doesn’t in terms of the non-surgical treatment options. We also go into great detail about the more invasive approaches like PRP, and of course, hair transplantation, a procedure which Alan has refined over the years into a proprietary method that seems to produce unbelievable results. Additionally, Alan provides tips for maintaining scalp health, which is vital for hair growth, as well as the importance of choosing a hair specialist who has the tools, expertise, and patience to develop a compassionate and encompassing approach to hair restoration. 

We discuss:

• Alan’s unique path, and how he became interested in hair transplantation [7:15];
• The prevalence of hair loss, types of hair loss, and the different patterns in men vs. women [15:45];
• The role of genetics in hair loss, and when does it start [19:00];
• Female hair loss: the role of hormones, pregnancy related hair loss, and what it means to have thinning and shedding [22:30];
• Primary drivers of male hair loss, finasteride as a treatment, and the potential side effects [26:15];
• Common treatments - Proscar, Propecia, Rogaine, and more - how they all came about and what you need to know [29:45];
• Primary drivers of female hair loss, potential treatments, and the different types of hair follicles [33:15];
• What are some of the unproven/snake oil methods of hair treatments being pushed to the public? [37:15];
• Preventative steps to take if you’re worried about future hair loss [42:00];
• Medications that may negatively affect hair quality [45:30];
• The importance of seeing a hair specialist [47:15];
• Impact of scalp health and inflammation on hair growth, how to pick and apply shampoo and conditioner, and how to avoid and treat hair breakage [50:15];
• Treatment options - finasteride, minoxidil, laser caps - how they work and what you need to know [57:15];
• PRP treatment: How it works, details of the procedure, and Alan’s proprietary protocol [1:11:45];
• The hair transplant procedure [1:29:30];
• Risks involved with a hair transplant procedure [1:44:00];
• Is a donor hair susceptible to the forces of the implant site that caused the hair loss? Can a hair follicle grow anywhere on the body? [1:47:45];
• Age appropriate procedures, how far the field has come, and why Alan loves his work [1:51:45]; and
• More.

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In this episode, Avrum Bluming, hematologist, medical oncologist, and emeritus clinical professor at USC and Carol Tavris, social psychologist and author of Mistakes Were Made (But Not By Me), discuss their collaboration on their recent book, Estrogen Matters. Their book takes on the very polarizing and confusing topic of hormone replacement therapy for women suffering with symptoms of menopause. In many ways, the story and history of HRT is in striking parallel to the bad science that led up to the dietary guidelines being set forth in 1980. Carol and Avrum make a compelling case that most women benefit greatly from being on postmenopausal hormone replacement therapy, and can do so without increasing their risk of breast cancer. We also cover the history of HRT, the impact of the Women's Health Initiative, and take a deep dive into each of the clinical conditions for which HRT should be considered, such as cardiovascular disease, neurodegenerative disease, and osteoporosis, to name a few.

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

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

We discuss:

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

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

We discuss:

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

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

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

 We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

• Rudy’s background, interest in obesity, and trying to understand the role and impact of adipose tissue [4:15];
• Finding the first evidence of leptin by studying obese mice [23:30];
• Zucker rats, and the push/pull theories of obesity [34:45];
• A breakthrough in obesity research, and closing in on leptin [45:45];
• Understanding leptin in humans [1:03:30];
• What Prader–Willi syndrome teaches us about body weight regulation [1:09:45];
• Leptin and the broad condition of obesity, metabolic consequences of weight reduction, and Peter’s self-experiments [1:18:00];
• How is appetite being regulated? [1:29:45];
• Are there epigenetic consequences of being obese? [1:37:00];
• What makes low-carb diets so effective at obesity reduction? [1:46:15];
• What did Rudy believe 10 years ago that he no longer believes to be true? [1:55:15];
• Rudy’s dream study of the FTO gene [1:57:15];
• What the hell does insulin resistance actually mean? [2:08:30]; and
• More.

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

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

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

We discuss:

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

Learn more at www.PeterAttiaMD.com

We discuss:

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

Learn more at www.PeterAttiaMD.com

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

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

We discuss:

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

Learn more at www.PeterAttiaMD.com