The Peter Attia Drive

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Paul Conti is an author and practicing psychiatrist who specializes in helping people heal from trauma. In this episode, Paul returns to The Drive to delve into the intricate relationship between emotional health, healthspan, and lifespan. He first challenges common assumptions about the inevitable decline of emotional health with age, providing strategies for conducting a comprehensive audit of internal emotional health. He establishes a framework for the foundation of good emotional health: a balance between the generative drive, the assertive drive, and the pleasure drive. Paul also explores the nuanced dynamics of motivation, happiness, and satisfaction as it relates to material possessions, draws connections between physical and emotional well-being, confronts the impact of negative self-talk, and describes how making peace with our mortality can foster a sense of hope, purpose and well-being. Additionally, Paul offers many practical insights into initiating emotional health improvements and navigating the search for a suitable therapist.

We discuss:

The importance of prioritizing emotional health as we age [2:45]; The impact of emotional health on healthspan and how to foster a proactive approach to emotional well-being [7:00]; The discrepancy between outward success and inner fulfillment, and the importance of a healthy ?generative drive? for genuine well-being [13:00]; A deeper dive into generative drive: impact on human behavior, resilience, purpose, and more [23:15]; Evaluating one?s inner self: introspection, self-awareness, challenging societal norms, and returning to the basics of physical and emotional well-being [29:00]; Self-auditing tools: introspection, curiosity, and exploring underlying reasons for unwanted behaviors [41:45]; Breaking free from destructive cycles by understanding the continuum of self-care and addictive behaviors and remaining curious [50:15]; Critical self talk: the malleability of one?s inner dialogue and the potential for transformative change with perseverance and self-compassion [1:00:15]; Slowing the anger response and gaining insights into the underlying triggers to achieve lasting change and self-understanding [1:13:45]; Foster gratitude and humility by achieving balance between the three drives?assertion, pleasure, and generative [1:20:45]; The conflict between intellectual understanding and emotional feelings, problematic comparison frameworks, and the importance of living in the present with intentionality [1:24:15]; How making peace with our mortality can foster a sense of hope, purpose and well-being [1:34:45]; Advice for finding a compatible therapist [1:43:45]; The key components of therapeutic progress [1:57:00]; The caricatures of four common patient phenotypes, and how to get through to them [2:05:30]; How Paul manages his own well-being and the emotional challenges that come with his line of work [2:15:15]; and More.

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In this ?Ask Me Anything? (AMA) episode, Peter delves into the crucial yet often overlooked topic of iron and iron deficiency. He explores why iron is indispensable for the body, explains the repercussions of iron deficiency, and sheds light on the prevalence of this issue and who is most susceptible. Peter outlines strategies for increasing iron levels, covering dietary iron, supplementation, and infusion options, while also discussing the suitability of each approach for different individuals. Shifting gears, Peter tackles rapid-fire questions on creatine and sodium, as well as inquiries related to his book.

If you?re not a subscriber and are listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #58 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Overview of today?s topics and the importance of understanding iron levels in the body [1:45]; The importance and ubiquity of iron in the body, and the role of the protein called ferritin [4:30]; The processes of iron absorption, utilization, and transportation [9:30]; Options for testing iron levels and how to interpret the results [13:45]; What does it mean to be iron deficient, and how is it different from anemia? [17:15]; Symptoms of iron deficiency and/or anemia [22:15]; How prevalent is iron deficiency, and who is most susceptible? [24:30]; The importance of consuming an adequate amount of iron daily to prevent deficiency [30:30]; The best way to improve iron levels for someone who is deficient [34:45]; Iron supplementation: various formulations and potential side effects [37:45]; Intravenous iron infusion as an alternative to oral supplements -- plus restless legs syndrome and other topics [42:00]; Iron supplementation: who should and should not consider it [44:00]; Peter?s approach to creatine and his pre- and post-workout supplements [50:15]; Navigating sodium intake: effect on blood pressure, who should use precaution, and other considerations [54:45]; Peter?s thoughts about the potential of writing another book [57:15]; and More.

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Courtney Conley is an internationally renowned foot and gait specialist. In this episode, Courtney delves into the intricate world of foot anatomy and functionality. She explores the complexities of the foot, discussing its anatomy, common injuries, and the importance of understanding its structure in preventing issues. She covers a range of foot ailments, factors contributing to them, treatment options, and prevention strategies. She delves into the significance of loading, balance, range of motion, and posture, emphasizing the crucial role of strength in preventing both injuries and falls. Additionally, she sheds light on the interconnectedness of the kinetic chain, from the leg muscles down to the foot, and how issues within this chain can cascade downstream, leading to various injuries and pathologies. Additionally, she provides a comprehensive overview of footwear, discussing suitable options for both adults and children to promote foot health and mitigate potential problems.

In addition to this interview, Courtney also recorded a series of videos to better explain a number of the concepts discussed such as diagnostic tests that are used to determine mobility and strength and the exercises one should perform to improve the outcomes based on the diagnostics. The interview will be available to everyone while the videos from the gym will only be available to paid subscribers (found at the end of the show notes page).

We discuss:

Why Courtney chose to specialize in the foot [3:30]; The vital role of foot strength, function, and health in human movement and well-being [6:15]; Anatomy of the rear foot and midfoot [10:15]; The development of flat feet, the impact of footwear, and the benefits of going barefoot [19:45]; Anatomy of the forefoot, common injuries, and why most injuries occur in the forefoot [23:15]; Foot musculature and its role in maintaining foot stability and preventing deformities like bunions and hammer toes [30:15]; The intrinsic musculature of the foot, plantar fasciitis, footwear, and more [39:00]; Plantar fasciitis: diagnosis, causes, and treatment [51:30]; Posterior leg muscles: strength assessment methods, role in ACL injuries, and more [59:15]; Lateral and medial muscles: ankle stability, arch support, big toe stabilization, and exercises to strengthen and prevent injuries [1:04:15]; Importance of strength of lower leg muscles for gait and preventing shin splints, stress injuries, and more [1:08:15]; Tendinopathies and other common pathologies related to the anterior and lateral compartments of the foot [1:13:00]; The importance of midfoot integrity, ankle dorsiflexion, and a discussion of gait alterations [1:19:45]; Proximal stability and its implications for posture and movement patterns [1:27:00]; The age-related decline in foot sensation and strength [1:32:45]; Common toe injuries, treatment, and how to prevent further progression of the injury [1:36:30]; Preventing falls and managing arthritis with proactive foot care and exercises [1:46:45]; Footwear: advice for picking shoes that promote foot health [1:54:45]; Footwear for runners [2:05:30]; The importance of prioritizing footwear that promotes natural foot movement and strength while considering individual comfort and foot health needs [2:09:30]; and More.

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Mark Rosekind is an expert on road safety and a policy leader with more than 30 years of experience enacting strategic, practical, and effective data-based solutions that enhance driver and pedestrian safety and health in complex environments. In this episode, Mark delves into the persistent issue of accidental deaths resulting from roadway accidents, a concern for those focused on longevity given its consistent risk throughout life. From exploring statistics on car crashes to identifying the demographics most at risk and the key locations of incidents, he uncovers various risk factors including distractions like smartphone usage, the influence of alcohol and cannabis, the dangers of sleep deprivation, and speeding. Mark also provides practical advice for both drivers and pedestrians to enhance safety, while delving into the potential and challenges of emerging technologies such as autonomous vehicles. Additionally, Mark provides valuable resources for listeners, particularly parents navigating the road safety landscape with teenage drivers.

We discuss:

Mark?s background and education, and the profound impact of transportation accidents on human lives [4:15]; From sleep science to safety leadership: Mark?s journey in transportation innovation [14:15]; Stats on transportation accidents and fatalities [18:00]; Historical trends in road fatalities and the key contributors?impairment, distraction, and more [28:00]; The demographics of drivers involved in crashes, and the life-saving potential of better driver education programs [34:30]; The most critical areas where drivers need to be hyper-aware to protect themselves [41:00]; The role of the National Transportation Safety Board (NTSB) in accident investigations, and the importance of data sources like event data recorders (EDRs) in accident reconstruction and investigations [47:00]; The dangers of phone use while driving [53:45]; How drunk driving was addressed through advocacy and legal changes [1:01:30]; The need to address distracted driving and the psychological impact of distracted driving accidents on both victims and perpetrators[1:07:15]; Navigating the roads and lowering your risk of accidents: weather, human error, and defensive driving [1:15:45]; The impact of impaired driving: alcohol, cannabis, prescription drugs, and more [1:26:15]; Mitigating the effects of vehicle speed [1:38:15]; The promise and challenges of autonomous vehicles for road safety [1:44:15]; Automatic emergency braking (AEB): the effectiveness and challenges of implementing AEB as a standard feature in new vehicles [1:53:00]; Sleep deprivation: the impact of poor sleep, drowsiness, and disrupted circadian rhythm on driving [1:58:15]; Protecting pedestrians: strategies for reducing the risk of fatal accidents with pedestrians on foot or bicycle [2:02:30]; Empowering safe driving: essential resources and tips for parents and teenage drivers [2:14:00]; Promoting a culture of proactive safety: parting thoughts from Mark [2:19:15]; and More.

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Olav Aleksander Bu is an internationally renowned sports scientist acclaimed for his coaching prowess with elite athletes spanning a diverse range of sports disciplines. In this episode, Olav delves deep into the intricacies of VO2 max and its profound impact on performance. They explore the relationship between VO2 max and ATP production, energy efficiency, and power, as well as the impact of low-intensity training on VO2 max. The conversation extends to Olav?s experiences pushing the boundaries with high-performance athletes and the data driven interventions he uses to improve performance. They also dissect the role of lactate threshold, discuss other important metrics to track, and explore the exciting possibility of utilizing a portable VO2 testing device as a practical alternative to traditional lab-based assessments.

We discuss:

Olav?s background, expertise in exercise physiology, coaching experience, and interest in the extremes of human capability [4:15]; The processes of energy conversion within the human body and its implications for performance [9:30]; Improving movement efficiency, and the importance of mindfulness in training to optimize performance [20:00]; The relationship between VO2 max, power output, and endurance performance in different sporting contexts [34:45]; How VO2 max is measured in the lab, and why it?s a crucial predictor of both lifespan and quality of life [44:45]; Absolute vs relative VO2 max, the significance of functional threshold power in cycling, and the importance of longer duration tests for accurate assessments [54:00]; Portable VO2 testing devices as a practical alternative to lab-based tests [1:05:15]; The complexities of measuring ventilation and its impact on performance metrics like VO2 max and heart rate [1:15:45]; Training interventions to increase VO2 max, and factors that impact performance outcomes [1:23:30]; The respiratory exchange ratio (RER) and endurance sports, and how factors such as diet composition and exercise intensity influence RER values and performance [1:32:45]; Science-guided training for versatile athletes: maximizing VO2 max, power, torque, and cadence in cycling, and the importance of incorporating diverse stimuli to enhance performance [1:41:00]; Physiological limitations on VO2 max [2:02:15]; The different energy systems used during work, and other things to monitor like VCO2 and heart rate [2:06:00]; Lactate threshold and other metrics to guide your training [2:10:30]; Analysis of a lactate power curve: exploring lactate dynamics in endurance training and performance [2:23:15]; and More.

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In this ?Ask Me Anything? (AMA) episode, Peter delves into the topic of high-intensity interval training (HIIT), starting with addressing some common misunderstandings around this type of exercise and breaking down what HIIT truly entails. He examines the correlation between HIIT and VO2 max, a vital metric for overall health and longevity, and describes the beneficial impact of HIIT on longevity when incorporated properly. Additionally, he emphasizes the importance of building a wide base of cardiovascular fitness, reveals the optimal protocols for incorporating HIIT into a balanced routine, and discusses the risk of injury and other potential drawbacks of HIIT.

If you?re not a subscriber and are listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #57 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Common questions about high-intensity interval training (HIIT) [1:30]; The origins of HIIT [3:15]; Defining HIIT training and differentiating it from sprint interval training (SIT) [5:45]; Why HIIT is often touted as a more efficient way to exercise [14:00]; Navigating the nuances of HIIT research: understanding limitations and the importance of a blended exercise routine [20:30]; The four pillars of exercise [24:15]; Using HIIT to improve VO2 max [26:00]; HIIT training for the untrained individual: impact on VO2 max and the interplay between exercise-induced adaptations and potential weight loss [33:00]; Sprint interval training (SIT) vs. HIIT: comparing the relative improvements in VO2 max and the impact of longer duration intervals [40:00]; Benefits and limitations of HIIT, drawbacks of overtraining with HIIT, and the importance of a diversified routine to increase total cardiorespiratory capacity [44:15]; HIIT protocols Peter recommends [58:45]; The risk of injury and other potential drawbacks of HIIT [1:02:15]; The importance of incorporating a balance of continuous moderate-intensity cardio and HIIT when aiming for longevity [1:04:00]; and More.

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Jason McCarthy is a former US Special Forces member and the founder of GORUCK, a company specializing in rucking equipment. In this episode, Jason recounts his journey from military service to navigating the challenging transition back into civilian life and ultimately embracing the mission of introducing rucking to the masses. Delving into the significance of rucking in military training and its applicability to the wider population, he discusses the mental and physical benefits of rucking as a mode of training, provides practical tips for beginners, and answers frequently asked questions about packs, weights, footwear, and more.

We discuss:

Jason?s upbringing and what inspired him to join the military [3:15]; Jason?s path to becoming a Green Beret, his calling to serve, and staying true to oneself [10:30]; About the Green Berets: their role in the military, unique abilities, missions, and more [20:00]; The mental and physical challenges of special forces training and selection [25:00]; Rucking challenges as a Green Beret [37:00]; How Jason trained in his off-time and stayed mentally prepared [46:30]; Jason?s difficult decision to leave the army, and the challenges many veterans face returning to civilian life [51:30]; Jason?s struggles after leaving the army: loss of identity, feelings of shame, and the how he overcame a period of despair [57:15]; The origin of GORUCK [1:10:30]; The GORUCK Challenge [1:24:30]; The company's evolution from event organizer to manufacturing specialist, spurred by the growing interest in rucking as a form of training [1:35:30]; FAQs about rucking: packs, weight, rucksack vs. weighted vest, chest straps, and more [1:38:45]; Commemorating Normandy: GORUCK's plans for the 80th anniversary of the Normandy landings [1:51:30]; Footwear for rucking, and how GORUCK got into the footwear business [1:57:30]; How to avoid the most common injuries from rucking, and the benefits of rucking for VO2 max, strength, and sleep quality [2:05:00]; Advice for using rucking as a mode of training, and the advantages of rucking over other forms of training [2:12:45]; and More.

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Derek is a fitness educator, the entrepreneur behind More Plates More Dates, and an expert in exogenous molecules commonly used and misused by bodybuilders and athletes. In this episode, Derek returns to the podcast to explore the impact of exogenous molecules on male and female health. He covers testosterone, DHT, DHEA, progesterone, clomiphene (Clomid), hCG, and various peptides, alongside updates from the FDA affecting peptide use. Additionally, he addresses the recent hype around increasing muscle mass through myostatin inhibition via follistatin gene therapy and supplementation. Additionally, Derek discusses the various strategies that bodybuilders use for losing fat while preserving muscle, including insights on weight loss drugs.

We discuss:

Testosterone and DHT: mechanisms of action, regulation of muscle growth, and influence on male and female characteristics [2:15]; TRT in women: the complexities and potential risks associated with testosterone use in women [9:00]; DHEA supplementation: exploring the benefits and risks for women, and the differing effects on men vs. women [22:00]; The role of progesterone in both men and women, pros and cons of supplementation, the importance of tailored doses, and more [28:00]; Measuring levels of free testosterone [37:15]; The trend towards earlier interest in TRT, and the risks of underground sources of testosterone [42:00]; The complexities and considerations surrounding the use of Clomid, E-Clomid, and hCG in TRT [46:00]; Low testosterone: diagnosis, potential causes, treatment options, and other considerations [53:45]; Growth hormone-releasing peptides: rationale and implications of the recent FDA categorization as high-risk substances [1:03:45]; Follistatin gene therapy and myostatin inhibition for increasing muscle mass: the recent hype online, human and animal data, and the need for more research [1:14:45]; Simple tips for lowering calorie intake and losing fat [1:32:30]; Methods of sustainable fat loss with muscle preservation: insights gleaned from bodybuilders [1:40:00]; Could prolonged fasting impact testosterone levels? [1:55:30]; High-protein ice cream [1:57:00]; Exploring fat loss supplements and drugs: L-carnitine, yohimbine, and more [2:02:15]; Potential remedies for individuals experiencing metabolic dysfunction due to hypercortisolemia [2:12:30]; The cornerstones of body composition improvement remain nutrition and exercise, even in the presence of exogenous testosterone [2:19:15]; The importance of approaching health advice found online with a critical eye and a healthy dose of skepticism [2:23:30]; and More.

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Alex Aravanis is a leader in research and development of technologies and clinical tests utilizing the latest tools in DNA analysis and data science. In this episode, Alex delves into two interconnected topics: liquid biopsies and epigenetics. He begins by tracing the trajectory of genome sequencing and tumor sequencing, setting the stage for a detailed exploration of liquid biopsies as an early cancer detection method. The discussion encompasses key concepts such as cell-free DNA, DNA methylation, sensitivity, specificity, and the predictive values associated with liquid biopsies. Transitioning to epigenetics, Alex examines the intricate interplay of DNA methylation and aging biology and explores the possibility of using cellular reprogramming to reverse epigenetic changes that occur with aging.

We discuss:

Alex?s background in applying engineering to problems in medicine [3:15]; A primer on human genetics, and the history and current landscape of DNA sequencing [11:00]; The advent and evolution of liquid biopsies for early detection of cancer [23:15]; The role of cell-free DNA in cancer detection: how incidental findings in non-invasive prenatal testing led to the development of liquid biopsies [40:15]; The development of a universal blood test for cancer detection and a discussion of specificity of tests [46:00]; Advancements in cell-free DNA analysis and development of a multi-cancer screening test at GRAIL [51:00]; DNA methylation explained [58:15]; Optimizing cancer detection with methylation analysis of cfDNA in small blood samples [1:02:45]; The importance of understanding sensitivity, specificity, positive predictive value, and negative predictive value in cancer screening [1:08:00]; The performance of the GRAIL Galleri test and its ability to detect various types and stages of cancer [1:21:00]; Do early cancer detection methods, like liquid biopsies, translate to improvement in overall survival? [1:27:45]; The role of epigenetics in aging [1:39:30]; How cell-free DNA methylation patterns can help identify a cancer?s tissue of origin [1:45:30]; Cellular and epigenetic reprogramming and other exciting work in the field of aging [1:52:30]; and More.

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In this ?Ask Me Anything? (AMA) episode, the conversation focuses on cancer screening, a topic often shrouded in confusion yet crucial to understand given that early identification of a cancer is an essential part of survival strategy. Peter examines the arguments both for and against cancer screening, including addressing why some trials may show no benefit to screening. He then delves into the various screening modalities available for different cancers, highlights the pros and cons associated with each, and explains how to interpret the results. Additionally, Peter provides guidance for navigating outside of the relatively narrow and confined screening guidelines for various types of screening tests.

If you?re not a subscriber and are listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #56 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Why understanding cancer screening is crucial [2:45]; The prevalence of cancer diagnosis and mortality rates [4:30]; Why cancer screening and early detection is such an important part of the strategy to survive a cancer diagnosis [11:00]; Data on how cancer screening impacts survivability of cancer [16:30]; Inconsistencies between cancer screening trials regarding benefits to survival rates [25:45]; What are some of the reasons why clinical trials don?t always improve cancer-specific mortality? [30:15]; What are the arguments against population-level cancer screening? [42:00]; Cancer screening outside the recommended guidelines: risks and benefits, interpreting results, and other considerations [46:00]; Understanding sensitivity and specificity when reviewing screening results [52:30]; Risks and complications associated with colonoscopies [55:45]; Cancer screening modalities: options for cancer screening both within standard recommendations and beyond [58:30]; The strengths and limitations of various types of cancer screening [1:02:15]; Understanding positive and negative predictive value using sensitivity, specificity, and pretest probability [1:11:45]; Factors that influence an individual's pretest probability of cancer [1:13:45]; How to interpret cancer screening results [1:18:15]; The importance of having an advocate when considering out-of-guideline cancer screening tests [1:23:30]; How stacking multiple cancer screening modalities can decrease the risk of false positives [1:29:30]; Advice and guidance for making decisions related to cancer screening [1:31:15]; and More.

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Walter Green is a remarkable philanthropist, mentor, author of This Is the Moment!, and founder of the impactful ?Say It Now? movement. In this episode, Walter delves into the unique insights gained from his challenging upbringing, discusses embracing mortality, and highlights the mindset of ?finishing strong.? He shares insights on intentionality, thinking in reverse, saying ?no,? prioritizing relationships, and the essence of focusing on others. The conversation focuses on the ?Say It Now? movement, which stresses the importance of expressing sentiments to loved ones well before the end of life.

We discuss:

How Peter and Walter met through Ric Elias [2:45]; The unique perspectives and life lessons provided by Walter?s challenging childhood [5:30]; Walter?s harrowing experience with a sudden mental breakdown and his subsequent recovery with the help of therapy [11:15]; A diverse professional journey ending in great success [18:15]; The birth of a movement: celebrating friendships through public tributes and expressing gratitude to those who have shaped your life?s journey [22:30]; Intentionality, thinking in reverse, saying ?no?, and other guiding principles for Walter [30:00]; Walter?s global journey of gratitude on his 70th birthday: visiting friends and creating memorable experiences [39:15]; The profound impact of acknowledging and expressing gratitude for the people who contribute to our lives [46:15]; The key elements for creating meaningful connections and cultivating deep, authentic friendships [52:15]; The ?Say It Now? movement: the inspiration behind the remarkably impactful initiative [58:30]; What ?finishing strong? means to Walter [1:07:30]; Finding peace at the end of life through expressing gratitude and finding purpose in serving others [1:16:00]; Resources to learn about ?Say It Now? [1:26:15]; and More.

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Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro Inc. where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling case studies of the successful treatment of complex cases of lower back pain, reinforcing his conviction that nobody needs to suffer endlessly. He also covers the importance of strength and stability, shares his favorite exercises to prescribe to patients, and provides invaluable advice for maintaining a healthy spine.

We discuss:

Peter?s experience with debilitating back pain [3:30]; Anatomy of the back: spine, discs, facet joints, and common pain points [14:45]; Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more [24:45]; Why the majority of back injuries happen around the L4, L5, and S1 joints [31:00]; How the spine responds to forces like bending and loading, and how it adapts do different athletic activities [36:15]; The pathology of bulging discs [43:15]; The pathophysiology of Peter?s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more [46:00]; The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types [56:15]; The significance of strength and stability in preventing injuries and preserving longevity [1:08:15]; Stuart?s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns [1:19:30]; Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain [1:30:00]; Empowering patients through education and understanding of their pain through Stuart?s clinic and work through BackFitPro [1:39:00]; When surgical interventions may be appropriate, and ?virtual surgery? as an alternative [1:46:45]; Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more [1:55:30]; Tarlov cysts: treatment and surgical considerations [2:00:15]; The evolution of patient assessments and the limitations of MRI [2:02:15]; Pain relief related to stiffness and muscle bulk through training [2:07:00]; Advice for the young person on how to keep a healthy spine [2:14:15]; Resources for individuals dealing with lower back pain [2:25:30]; and More.

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Andrew Huberman, professor of neurobiology at Stanford University and host of the Huberman Lab podcast, returns for another special journal club episode. Andrew introduces an observational study investigating the influence of light exposure on circadian clock regulation and its link to mental health, while Peter covers a phase III clinical trial employing immune checkpoint inhibitors for the treatment of metastatic cancer. They delve into the essential findings of their respective papers, elucidate the reasons for their enthusiasm, and tackle potential limitations and unanswered questions. Additionally, they provide valuable insights into their approaches for comprehending research studies, aiding listeners in independently navigating this process.

We discuss:

The intricate relationship between light exposure, circadian rhythms, and mental health [3:30]; The importance of low solar angle sunlight, and other types of light needed for optimal mental and physical health [12:00]; Promising new lightbulb technology that simulates low solar angle sunlight [17:45]; The significance of both darkness and the need for direct light exposure to the eyes, specifically [20:00]; Some tips and advice regarding optimizing light exposure, blue blockers, and effects on circadian rhythm [22:15]; Andrew presents a paper which suggests avoiding light at night and seeking light during the day is associated with better mental health [25:45]; Examining the data: the negative impact of increasing nighttime light exposure and the positive effects of daytime light exposure [34:30]; Statistical analysis: the importance of focusing not only on statistical significance but also clinical relevance, power analysis, error bar range, and more [45:45]; Takeaways from the study of daytime and nighttime light exposure [49:45]; The practicalities of minimizing light exposure and screen time at night, the use of sleep trackers, and overall challenge of modern, indoor lifestyles [55:15]; Potential limitations of the light exposure study, reverse causality, and the complex interplay of variables in epidemiological studies [1:06:00]; A tangent on diet soda and sugar substitutes as an example of reverse causality [1:13:15]; Andrew and Peter?s take on the causality vs. correlation of light exposure to mental health, the damage of circadian disruption, and the interpretation of observational data [1:17:30]; A primer on the immune system as background for the paper Peter chose [1:25:00]; Background on cancer: causes, how it evades the immune system, and the logic behind immune checkpoint inhibitor therapy [1:35:45]; Peter presents a paper on immune checkpoint inhibitor therapy in cancer patients [1:50:15]; Unpacking the results of the checkpoint inhibitor trial [1:59:45]; Other noteworthy observations, including the differing results between males and females [2:15:30]; Adverse effects resulting from treatment with an immune checkpoint inhibitor targeting CTLA-4 [2:20:00]; Why melanoma is especially responsive to immunotherapy, and the remarkable success story of immunotherapy for pancreatic cancer [2:25:15]; Why immunotherapy may be the most important hope we have for treating cancer [2:35:30]; Avoiding melanoma: the sunscreen debate, sunburn as the biggest risk factor, and more [2:38:45]; and More.

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In this ?Ask Me Anything? (AMA) episode, Peter delves into the crucial topic of exercise, starting with the importance of having a goal in training, including how and why Peter uses the goal of training for the ?Centenarian Decathlon? when structuring his training plans. Peter elaborates on how to identify deficient areas within the four pillars of exercise and guides listeners on incorporating periodization training for optimal improvement and training variety. The episode explores diverse case studies, offering insights into tailored workouts for individuals of various training backgrounds, from seasoned enthusiasts to complete beginners. Additionally, Peter tackles the universal issue of emotional stress and its impact on training, as well as how exercise can help manage stress and how to determine when training should be adjusted during a high-stress period.

If you?re not a subscriber and are listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #55 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Overview of exercise topics [2:15]; Importance of training with a goal in mind, the Centenarian Decathlon, and the natural decline of fitness with age [4:00]; The four pillars of exercise [12:15]; Measuring peak aerobic output with VO2max, and the importance of VO2max as a predictor of longevity [16:45]; Measuring aerobic efficiency with zone 2 [25:45]; Measuring and tracking muscle mass and strength [27:30]; Case study of a fit person with a neglected pillar: why adding more training volume may not the best strategy [30:30]; Periodization training: what it is and why it is beneficial [36:15]; Periodization case study: high cardio fitness, lacking muscle and strength [40:00]; Periodization case study: adequate muscle, low cardio fitness [44:45]; Case study: significant improvement needed across all exercise pillars [48:45]; Best ways to do zone 2 exercise and how to use relative perceived exertion (RPE) to find your zone 2 level [56:30]; How the body responds to physical and emotional stress, its impact on training, and the consequences of chronic stress [1:01:00]; The difference between ?good? stress and ?bad? or chronic stress [1:10:30]; The complex relationship between exercise and stress, and the importance of adjusting exercise goals during high-stress periods [1:13:30]; Clues that stress may be impacting your training [1:19:15]; The use of wearables and devices for tracking trends and making decisions related to training [1:21:00]; Parting thoughts regarding the importance of exercise for longevity and stress management [1:32:00]; and More.

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Bestselling author Michael Easter returns to The Drive to discuss his new book, Scarcity Brain. In this episode, Michael explores the evolutionary backdrop that molded human beings, a setting characterized by scarce food, limited information, and few possessions. He contrasts that with the modern era, marked by abundance and comfort, and the ensuing repercussions on our physical and mental well-being. Michael introduces the concept of the ?scarcity loop,? a three-part behavior cycle which helps explain modern challenges such as overeating, addiction, gambling, and materialism, and offers practical strategies to break free from its cycle. The episode culminates in a thought-provoking exploration of happiness, drawing on Michael's experiences with monks and underscoring the value of boredom, exploration, and discomfort as transformative elements that elevate awareness, presence, and the will to live.

We discuss:

Inspiration for Michael?s latest book, Scarcity Brain [2:15]; Evolutionary adaptations to the scarcity of food contrasted with the modern obesity crisis [4:00]; Lessons learned about diet and nutrition from living with hunter-gatherers [9:30]; The impact of ultra-processed foods on energy balance [20:30]; Michael?s experience with attempting the hunter-gatherer diet at home [27:30]; The roots of excess: factors that contribute to overeating and the varied vulnerabilities among individuals [34:00]; The scarcity loop: how components of the scarcity loop are illustrated in gambling and addiction [39:45]; Using knowledge of the scarcity loop to break the cycle [50:45]; The evolutionary drive to acquire material possessions [58:15]; The benefits of boredom and value of exploration [1:07:00]; The consequences of an attention economy driven by negativity bias [1:16:30]; Navigating the world of endless information and the value in ?slow information? [1:23:00]; Defining happiness, and the downward trend in reports of happiness [1:33:00]; Purpose, austerity, self-reliance and other missing elements of happiness gleaned from the study of monks [1:38:30]; The value in uncomfortable activities that increase your awareness, presence, and will to live [1:48:45]; and More.

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James Clear is the author of the New York Times bestseller Atomic Habits. His extensive research into human behavior has helped him identify key components of habit formation and develop the ?Four Laws of Behavioral Change.? In this episode, James provides insights into how both good and bad habits are formed, including the influence of genetics, environment, social circles, and more. He points to changes one can make to cultivate more perseverance and discipline and describes the profound impact habits can have when tying them into one?s self-identity. Finally, James breaks down his ?Four Laws of Behavioral Change? and how to use them to create new habits, undo bad habits, and make meaningful changes in one?s life.

We discuss:

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

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Colleen Cutcliffe is an expert in molecular biology and co-founder of Pendulum Therapeutics, a company working to develop treatments for a variety of diseases by targeting the microbiome. In this episode, Colleen delves into the complexity of the microbiome, how it is tested, and how it changes over time. She explores how probiotics, prebiotics, and postbiotics affect the gut and makes a compelling case that well-developed products have the potential not only to enhance gut health but also to positively influence overall metabolic well-being. Colleen emphasizes the significance of a high-fiber diet in sustaining a thriving gut microbiome, shares insights on minimizing microbiome damage during antibiotic use, provides tips for fostering and preserving a healthy gut, and much more.

We discuss:

Colleen?s background and current focus [4:45]; The basics of the microbiome [7:15]; The study of the human microbiome [15:15]; Categories of bacteria, and the implications on health of the rapid evolution of bacteria [19:45]; Methods for measuring and understanding the microbiome, and key indicators of microbiome health [28:30]; The important role of fiber for promoting gut health through the production of butyrate [38:30]; The case for manipulating gut bacteria via fecal microbiota transplant (FMT) [45:00]; Dynamics of the microbiome: the gut-brain connection and how antibiotics, nutrition, stress, and more impact the microbiome's diversity and function [50:15]; Factors that influence the vaginal microbiome [55:15]; The effect of gut microbes on obesity and challenges with fecal transplants in people [58:45]; Beneficial strains of gut bacteria and strains commonly found in probiotics [1:01:15]; The difference between a probiotic and prebiotic, and how CFUs are a measure of the ?active ingredient? [1:09:45]; Considerations about how probiotic strains are produced, and more on the meaning of CFU [1:14:15]; Mitigating the effect of antibiotics on the microbiome [1:22:30]; What do we know about the effect of artificial sweeteners on the gut microbiome? [1:30:00]; Why Akkermansia is a keystone strain with implications for metabolic health and an individual?s response to dietary interventions [1:36:15]; The essential steps necessary to develop a robust probiotic for optimal health support [1:45:45]; How Akkermansia helps control blood glucose, and potential implications of Akkermansia in weight loss, diabetes management, and more [1:48:45]; Pendulum Therapeutics? commitment to rigorous product develop [2:06:30]; Details about the probiotic ?Glucose Control? and other probiotics developed by Pendulum Therapeutics [2:13:00]; Further studies of Akkermansia that have been proposed or are underway [2:20:30]; and More.

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In this ?Ask Me Anything? (AMA) episode, Peter tackles essential questions about magnesium, beginning with the important roles it plays in the body and why maintaining proper levels is crucial. Peter discusses the harms of magnesium deficiency, how to determine if you're deficient, potential causes of deficiency, and how diet and supplementation can be used to increase magnesium levels. Peter unravels the confusion surrounding magnesium supplementation, discussing the optimal forms and recommended daily intake while addressing concerns about excess consumption. He also explores the potential cognitive and sleep benefits associated with magnesium supplementation. Finally, Peter concludes with a look into his recent experimentation with new exercises to serve as benchmarks to assess his progress and fitness levels as he navigates the aging process.

If you?re not a subscriber and are listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #54 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

The important roles of magnesium in the body [2:45]; How to determine if you might be deficient in magnesium [10:15]; Addressing migraines related to low magnesium [14:45]; The prevalence of magnesium deficiency [16:30]; Various conditions and drugs that can negatively impact magnesium levels [21:30]; Magnesium-rich foods and factors that impact absorption of magnesium [24:30]; Daily targets for magnesium supplementation and whether it?s possible to take too much [30:15]; The different forms of supplemental magnesium [34:00]; How absorption of magnesium from food compares to absorption from supplements [36:15]; Choosing the right magnesium supplements for optimal absorption [37:15]; The unique ability of magnesium L-threonate to increase brain magnesium concentration [40:15]; Potential cognitive benefits of magnesium [43:00]; Potential sleep benefits of magnesium [48:45]; Takeaways on magnesium and a look into Peter?s personal protocol [53:15]; Peter?s new benchmarks related to exercise and age [58:30]; and The potential impact of hearing loss on brain health and neurodegeneration [2:04:30]; and More.

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Richard Miller is a professor of pathology and the Director of the Center for Aging Research at the University of Michigan, as well as a previous guest on The Drive. In this episode, Rich provides an update on the exciting work of the Interventions Testing Program (ITP), an initiative designed to assess potential life-extending interventions in mice. Rich covers the notable successes like rapamycin, 17?-estradiol, and acarbose as well as notable failures like nicotinamide riboside, metformin, and resveratrol, providing valuable lessons about the intricacies of the aging process. Rich delves deep into aging biomarkers and aging rate indicators, unraveling crucial insights into the science of geroprotective molecules. Additionally, Rich discusses some surprising successes of recent molecules tested by the ITP and concludes with an optimistic look at future frontiers, including bridging the gap from mice to humans.

We discuss:

An overview of the Interventions Testing Program (ITP) [3:45]; How the mice used by the ITP are superior for research relative to mouse models used in most research [11:15]; Design of ITP studies, outcomes tested, and metrics of interest [19:00]; The process and challenges of drug formulation for mice [30:00]; Four drugs identified by the ITP that extends the lifespan of mice [36:30]; The success of rapamycin and what it tells us about the biology of aging [43:15]; Other measures of healthspan evaluated by the ITP in stage 2 studies [50:45]; Distinguishing aging rate indicators from biomarkers of aging [57:30]; Aging rate indicators identified through the examination of slow-aging mice [59:15]; Why proteomics are essential to understand changes in the cell [1:12:15]; Unraveling aging rate indicators: dose-effect, duration, and future frontiers [1:21:45]; A closer look at aging rate indicators: bridging the gap from mice to humans [1:27:00]; What do laboratory mice die from? [1:38:45]; Distinguishing between a drug that improves an age-sensitive outcome and a drug that improves all aspects of aging [1:42:00]; The ITP study of 17?-estradiol: mechanisms of life extension and surprising sex differences [1:43:30]; Unsuccessful drugs studied by the ITP: resveratrol, metformin, and nicotinamide riboside [1:51:30]; Over-the-counter successes in the ITP: meclizine and astaxanthin [2:01:00]; A senolytic drug, fisetin, fails to extend lifespan [2:07:00]; Can targeting senescent cells slow aging? [2:13:00]; Optimism about future findings [2:16:30]; and More.

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Arthur Brooks is a social scientist, professor at Harvard University, columnist for The Atlantic, and bestselling author. In this episode, Arthur returns to the podcast to discuss his new book, Build the Life You Want. He delves into the nuanced concept of happiness, differentiating between momentary feelings and overall wellbeing. He explains the importance of understanding one?s personality pattern with respect to positive and negative emotions in order to better self-manage emotions. He delves into the three key elements of happiness, offering practical strategies for enhancing those specific domains through methods such as metacognition, transcendent experiences, discipline, minimizing self-focus while directing attention outward, and more. Through personal examples, Arthur demonstrates that one can actively track well-being levels and take intentional steps to cultivate happiness and enhance overall well-being.

We discuss:

Happiness vs. happy feelings, and how happiness and unhappiness can coexist [4:30]; The six fundamental emotions [8:00]; The evolution and heritability of happiness, and the four personality patterns with respect to positive and negative emotions [17:30]; Navigating relationships: the power of complementarity over compatibility [23:30]; The importance of self-managing your mental habits [25:30]; Enjoyment: one of the three macronutrients of happiness [32:00]; Satisfaction: one of the three macronutrients of happiness [43:45]; The reverse bucket list, metacognition, and other techniques to protect yourself from your limbic system [51:00]; Meaning: one of the three macronutrients of happiness [57:30]; The four quarters of your life and how that relates to the meaning of your life [1:05:00]; Putting metacognition into practice [1:09:00]; What might explain the societal downdrift in happiness over the last few decades? [1:17:00]; Taking charge of your happiness: discipline, transcendent experiences, and other deliberate actions for happiness [1:30:30]; Tracking happiness: biomarkers and micronutrients behind the macronutrients of happiness [1:42:00]; The value in minimizing the self and looking outward [1:49:45]; How Arthur surprised himself with his ability to improve his happiness [1:54:00]; and More.

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To support Tom?s mission and work, please visit: https://africanmissionhealthcare.org/donation/catena/.

 

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 to 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.

We discuss:

Background, medical training, and early days of missionary work in Africa [5:15]; Tom arrives at Mother of Mercy Hospital in the Nuba Mountains of Sudan, civil war breaks out, and his staff evacuates [12:30]; Learning surgery on the job and earning the trust of the community [37:00]; The amazing people of Nuba, and why Nuba feels like home to Tom [47:45]; NY Times article about Tom?s work, and Tom?s new venture on the board of the Aurora Prize Foundation, raising awareness and funds for other missionaries [59:45]; Tom?s mind-blowing ability to deal with chaos while seeing hundreds of patients per day [1:12:00]; The most afraid Tom has ever been, and how he copes with the emotional trauma of his daily experiences [1:19:45]; The basic tools, technologies, and medicines that Tom is lacking that could save many lives [1:30:00]; The logistical challenge of helping Tom?s hospital, and what Tom really needs [1:35:15]; Diseases in the adult population [1:38:30]; Living without possessions, finding meaning, and being a missionary [1:55:45]; Happiness, sense of purpose, and suicide: contrasting the US with Nuba [2:07:15]; Other than donations, is there a way people can help Tom and other similar causes? [2:15:15]; The food in Nuba [2:18:30]; Tom?s annual bout of malaria [2:23:45]; Patients Tom will never forget [2:26:00]; Resources for people wanting to get involved in helping Tom?s work [2:31:00]; Peter tells a story that defines Tom [2:32:00]; and More.

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In this ?Ask Me Anything? (AMA) episode, Peter explores various pharmacologic tools commonly utilized to improve metabolic health and treat diabetes, including SGLT-2 inhibitors, metformin, and GLP-1 agonists. He examines the available data on these drugs, assessing their comparative effectiveness and their potential in the context of lifestyle interventions. Additionally, he offers insights into whether SGLT2 inhibitors hold promise as geroprotective agents beyond their effects on glycemic control. Next, Peter analyzes the relationship between statin usage and the risk of developing insulin resistance and type 2 diabetes, investigating possible causal pathways and providing insights into strategies for risk reduction. He offers insights on monitoring adverse statin effects and evaluating the need for adjustments, ultimately weighing the trade-off between the risk to overall metabolic health against the benefits of reducing apoB levels through statin use.

If you?re not a subscriber and are listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #53 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Pharmacologic tools for improving metabolic health, and the relationship between statins and insulin resistance [2:00]; SGLT-2 inhibitors: how they work and help to manage type 2 diabetes [4:15]; The history of SGLT2 inhibitors ? from discovery to the current state [10:15]; Comparing the various FDA-approved SGLT2 inhibitors [15:00]; Other beneficial effects of SGLT2 inhibitors outside of glycemic control [20:15]; Exploring SGLT2 inhibitors as potential geroprotective molecules [22:45]; The side effects and risks associated with SGLT2 inhibitors [31:45]; Medications, lifestyle interventions, and other considerations for treating diabetes and improving metabolic health [37:45]; Metformin as a tool for pre-diabetics, and how metformin compares to lifestyle interventions [44:00]; How GLP-1 agonists compare to metformin and SGLT2 inhibitors in terms of glycemic control and weight loss [49:15]; Exploring the relationship between statin use and the risk of developing insulin resistance and type 2 diabetes [52:30]; Possible mechanisms of statin-induced insulin resistance and diabetes, and potential mitigation strategies [1:04:30]; How to monitor for adverse effects of statin use and assess the need for adjustments [1:11:45]; Weighing the benefits and risks of statin use: does the diabetes risk outweigh the benefits of lowering apoB with a statin? [1:15:30]; Parting thoughts [1:20:45]; and More.

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Harold (Hal) Burstein is an internationally renowned breast cancer expert. In this episode, Hal discusses a broad range of topics related to breast cancer, starting with the intricacies of breast anatomy and the endocrinological factors at play. He covers the spectrum of breast cancer, from precancerous lesions to invasive breast cancer, classifying these conditions into a helpful framework. He delves into various screening methods, including self-exams, mammograms, ultrasounds, and MRIs, and addresses the ongoing debate surrounding early screening and detection. Hal provides insights into the latest advancements in cancer treatment, offering valuable guidance for individuals to understand their unique circumstances within the three primary categories of breast cancer. Finally, Hal delves into the role of genetics in breast cancer and brings attention to the less commonly addressed issue of male breast cancer.

We discuss:

The prevalence and mortality rate of breast cancer in women [4:15]; The anatomy of the breast and the complex factors behind breast cancer development [6:30]; The three main categories of breast cancer [16:45]; Breast cancer risk: the impact of menopause, estrogen, breast density, obesity, and more [21:15]; Finding and evaluating lumps in the breast [25:30]; Identifying and treating precancerous lesions like ductal carcinoma in situ (DCIS) [31:00]; Post-lumpectomy for DCIS: standard of care, future risk of cancer, and pros and cons of radiation and other preventative options [41:15]; Lobular carcinoma in situ (LCIS): how it differs from DCIS in terms of treatment and future risk of invasive cancer [55:00]; Breast cancer screening: mammography, ultrasound, MRI, and more [1:03:45]; Invasive breast cancer: pathology report, surgery, and survival [1:11:00]; The argument for aggressive screening for breast cancer [1:22:15]; Advances in the treatment of breast cancer, adjuvant therapy, and neoadjuvant therapy [1:27:00]; The use of hormone replacement therapy in women who are in remission from breast cancer [1:41:15]; The role of genetics in breast cancer [1:44:45]; The importance of multidisciplinary care delivered by cancer centers [1:53:15]; Breast cancer in men [2:03:30]; Parting thoughts and takeaways [2:05:45]; and More.

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Kari Nadeau is a physician scientist with expertise in treating food allergies. In this episode, Kari first explains the fascinating workings of the immune system, exploring how it adeptly defends against bacteria and viruses but how the same system can lead to food allergies. She proceeds to explore the complexities of food allergies, detailing their typical developmental patterns, underscoring the significance of preventative approaches like early exposure, and highlighting the potentially life-threatening nature of severe food allergies. Kari illuminates the latest advancements in immunotherapies that not only mitigate allergy severity but also hold the potential to completely cure the patient. Additionally, Kari shares her concerns about the increasing levels of air pollution, elucidating its adverse effects on health while providing valuable suggestions for reducing exposure.

We discuss:

Kari?s motivation to study food allergies [4:00]; Overview of the immune system and the family of immunoglobulins [9:00]; How our immune system fights viruses, bacteria, or fungi, and some exceptions to the rule [13:00]; Why our immune system is generally better at fighting viruses than bacterial infections [18:45]; Differentiating a food sensitivity from a food allergy, and a discussion about celiac disease [25:30]; How food allergies develop, why they can be lethal, and factors contributing to the uptrend in food allergies [35:45]; The role of environmental factors in the onset of food allergies and strategies for prevention [50:15]; How immunotherapy helps to overcome, and even cure, food allergies [1:04:15]; Can immunotherapy work for environmental allergens like pollen? [1:24:00]; Air pollution: impact on health and tips for reducing your risk [1:25:30]; Resources for those wanting to learn more or find clinical trials related to food allergies [1:40:45]; and More.

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In this special episode of The Drive, Peter discusses a variety of topics, breaking away from the typical deep-dive format to explore a wide range of common questions submitted by listeners. Peter tackles subjects like the viability of living to 120 and beyond, addressing some of the optimistic theories regarding achievement of this remarkable feat. Peter then shares his drug and supplement regimen while emphasizing how individualized these protocols need to be. The conversation also touches on lowering apoB, the long-term use of statins, the myth of good vs. bad cholesterol, the complexities of nutrition research, the quest for the ideal diet, and Peter's strategies for hitting daily protein goals. Peter finishes with a discussion about his favorite health-tracking wearables, the role of CGM in non-diabetics, and more.

We discuss:

Overview of topics and previous episodes of a similar format [2:45]; The viability of living to 120 and beyond: some optimistic theories [4:45]; The potential of mTOR inhibition as a mid-life intervention, and longevity potential for the next generation [13:30]; A framework for thinking about geroprotective drugs and supplements in the context of a lack of aging biomarkers [17:00]; Supplements Peter takes and how his regimen has changed in the last year [26:15]; Pharmacologic strategies to lower ASCVD risk, the limitations of statins, nutritional interventions, and more [36:15]; Misnomers about cholesterol [48:00]; Why nutritional research is so challenging, some general principles of nutrition, and why Peter stopped doing prolonged fasts [50:45]; Optimizing protein intake [59:45]; Wearables for sleep and exercise, continuous glucose monitors (CGM), and a continuous blood pressure monitor on the horizon [1:04:45]; and More.

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In this "Ask Me Anything" (AMA) episode, the discussion zeroed in on the practical application of hormone replacement therapy in women. Peter walks through the signs, symptoms, and hormonal changes in women approaching ? and going through ? menopause. He provides an overview of the FDA-approved HRT formulations and explains how women might go about choosing the right option for themselves. Peter also describes the significant changes in testosterone levels in women over time and the options, as well as the considerations and challenges of testosterone replacement therapy (TRT) for women. Lastly, Peter highlights the necessary role of compounding pharmacies in HRT, underscores concerns regarding the quality and sterility of compounded drugs, and offers guidance on locating a trustworthy pharmacy.

If you?re not a subscriber and are listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #52 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Why hormone replacement therapy is such an important topic [2:00]; The onset of menopause: symptoms, blood tests, and when to consider HRT [6:00]; Tests that may provide indications of perimenopause and their implications for fertility [9:15]; Vasomotor symptoms: hormonal changes that cause hot flashes/night sweats, and HRT therapies that can help [13:45]; The role of estrogen in menopausal HRT [17:30]; The limited role of progesterone in HRT protocols [25:15]; What is a ?bioidentical? hormone? [28:30]; Overview of the FDA-approved HRT formulations [31:45]; Determining HRT dosing and considerations for perimenopausal women [37:45]; Choosing the right HRT formulation: pros and cons [43:30]; Examining the link between certain forms of estrogen and breast cancer [46:45]; Changes in testosterone levels in women over time and why it matters [50:00]; Recognizing low testosterone in women: common symptoms and diagnosis [53:45]; Testosterone replacement therapy for women: options, considerations, and challenges [57:30]; The long-term use of testosterone in women: examining the limited data [1:00:15]; What is a compounding pharmacy? [1:09:30]; Reasons to opt for a compounding pharmacy over a pharmacy that adheres to stricter regulations [1:16:00]; The tragic incidents that heightened concerns about compounding pharmacies [1:20:45]; Tips for finding a reputable compounding pharmacy [1:27:45]; and More.

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We discuss:

Derek?s interest in weightlifting and experimentation with anabolic steroids at a young age [3:15]; Derek?s experience acquiring steroids from underground labs and the potential long-term fertility concerns early in his bodybuilding career [12:00]; The backstory on More Plates, More Dates and Derek?s unique ability to blend scientific knowledge with personal observation [17:00]; Growth hormone ? from extreme use-cases to the more typical ? and the misconception that it?s the ?elixir of life? [21:30]; Growth hormone 101: definition, where it comes from, and the challenges of measuring it [28:45]; Does exogenous growth hormone compromise one?s ability to make endogenous growth hormone? [40:00]; The use of growth hormone in restoration of tissue during periods of healing [42:00]; Growth hormone-releasing peptides to increase endogenous GH: various peptides, risks, benefits, and comparison to exogenous growth hormone [48:45]; The role of growth hormone in building muscle and burning fat, as well as its effects on sleep and daytime lethargy [1:02:30]; The evolution of drug use in the sport of bodybuilding [1:10:30]; What explains the protruding abdomens on some bodybuilders and athletes? [1:20:30]; Death of bodybuilders [1:26:00]; The complex interplay of hormones, and the conversion of testosterone into metabolites like DHT and estrogen [1:33:45]; Post-finasteride syndrome and how Derek successfully treated his hair loss [1:43:15]; Testosterone replacement therapy: compelling use-cases, side effects, and optimal dosing schedules [1:57:15]; Aromatase inhibitors to suppress estrogen, and the misconceptions around estrogen in men [2:16:00]; Other hormones beyond testosterone for male sex hormone replacement [2:21:00]; The history of anabolic compounds, and the differing effects of various anabolic testosterone derivatives and related drugs [2:24:30]; Use of SARMs by bodybuilders [2:29:45]; Anabolic steroid and testosterone regimens of professional bodybuilders and the downstream consequences [2:36:15]; The challenge of accurate hormone testing in the presence of anabolic steroids and supplements [2:44:45]; The use of Clomid, hCG, and enclomiphene [2:47:15]; Concerns about fertility: comparing the use of testosterone and hCG [3:00:30]; The use of BPC-157 peptide for healing injuries [3:12:00]; and More.

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Ted Schaeffer is an internationally recognized urologist who specializes in prostate cancer. In this episode, Ted delves deep into the realm of prostate health, starting with strategies for vigilance and effective management of the issues that can arise with aging, including urinary symptoms, prostatitis, pelvic pain, and prostate inflammation. Ted sheds light on the popular drug finasteride, renowned for its dual purpose in prostate shrinkage and hair loss prevention, as well as the contentious topic of post-finasteride syndrome. Ted then shifts to the topic of cancer, explaining how androgens, genetics, and non-genetic factors contribute to the pathogenesis of prostate cancer. He provides valuable insights into cancer screening, examining blood-based screening tools like PSA and the use of MRI in facilitating biopsies and their interpretation. Finally, he explores the various treatment options for prostate cancer, including surgical interventions, androgen deprivation therapy, and more.

We discuss:

Changes to the prostate with age and problems that can develop [3:45]; Behavioral modifications to help manage nocturnal urinary frequency and other lower urinary tract symptoms [8:30]; Pharmacologic tools for treating nocturnal urinary frequency and lower urinary tract symptoms [16:30]; Surgical tools for treating symptoms of the lower urinary tract [26:15]; HoLEP surgery for reducing prostate size [32:30]; Prostate size: correlation with cancer and considerations for small prostates with persistent symptoms [40:30]; Prostatitis due to infection: symptoms, pathogenesis, and treatment [46:45]; Prostatitis caused by factors besides infection [58:45]; How to minimize risk of urosepsis in patients with Alzheimer?s disease [1:05:00]; Prostate cancer: 5-alpha reductase inhibitors, how androgens factor into pathogenesis, and more [1:10:00]; Post-finasteride syndrome [1:18:15]; The relationship between testosterone and DHT and the development of prostate cancer over a man's lifetime [1:26:30]; How genetic analysis of a tumor can indicate the aggressiveness of cancer [1:35:15]; Pathogenesis and genetic risk factors of prostate cancer and the use of PSA to screen for cancer [1:37:45]; Non-genetic risk factors for prostate cancer [1:45:45]; Deep dive into PSA as a screening tool: what is PSA, definition of terms, and how to interpret results [1:56:30]; MRI as a secondary screening tool and the prostate biopsy options [2:13:15]; Ted?s ongoing randomized trial comparing different methods of prostate biopsy [2:24:00]; Determining when a biopsy is necessary, interpreting results, explaining Gleason score, and more [2:27:00]; Implications of a Gleason score of 7 or higher [2:46:45]; Metastasis of prostate cancer to different body locations, treatment options, staging, and considerations for patients' quality of life and survival [2:53:30]; How prostate cancer surgery has improved [3:09:30];; Questions to ask your neurologist if you are considering prostatectomy for cancer [3:21:45]; and More.

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In this episode of The Drive, Peter welcomes guests David Sabatini and Matt Kaeberlein, two world-leading experts on rapamycin and mTOR. David and Matt begin by telling the fascinating story of the discovery of rapamycin and its brief history as a pharmacological agent in humans. They then unravel the function of mTOR, a central regulator of numerous biological processes, and they discuss the pathways through which rapamycin exerts its potential benefits on lifespan. They touch upon initial studies that suggested rapamycin may have geroprotective effects and the ongoing research that continues to shed light on this unique molecule. Furthermore, they discuss the elusive details surrounding the frequency and dosing of rapamycin use in humans, and Peter emphasizes his reservations about indiscriminately prescribing rapamycin as a longevity drug for patients.

We discuss:

David and Matt?s expertise in mTOR and rapamycin [3:00]; The discovery of rapamycin and its first use in humans as an immunosuppressant [13:15]; The emergence of rapamycin as a molecule with the potential to prolong lifespan [19:30]; The groundbreaking rapamycin study on mouse lifespan extension and the open questions about the timing and frequency of dosing [26:00]; Explaining mTOR and the biology behind rapamycin?s effects [35:30]; Differences in how rapamycin inhibits mTOR complex 1 (MTORC1) versus mTOR complex 2 (MTORC2) [45:15]; Reconciling the biochemical mechanism of rapamycin with its longevity benefit [49:15]; Important discoveries about the interplay of amino acids (leucine in particular) and mTOR [54:15]; Reconciling rapamycin-mediated mTOR inhibition with mTOR's significance in building and maintaining muscle [1:01:30]; Unanswered questions around the tissue specificity of rapamycin [1:08:30]; What we know about rapamycin?s ability to cross the blood-brain barrier and its potential impacts on brain health and neurodegeneration [1:13:45]; Rapamycin may act as an immune modulator in addition to immunosuppressive effects [1:21:30]; Might rapamycin induce changes in T cell methylation patterns, potentially reversing biological aging? [1:34:15]; Rapamycin side effects and impacts on mental health: fascinating results of Matt?s survey on off-label rapamycin use [1:42:00]; The impact of taking rapamycin in people who contracted COVID-19: more insights from Matt?s survey [1:51:15]; What David would like to study with mTOR inhibitors [1:54:45]; Joan Mannick?s studies of RTB101 and other ATP-competitive inhibitors of mTOR [2:00:30]; The impact of mTOR inhibition on autophagy and inflammation and a discussion of biomarkers [2:10:00]; The Dog Aging Project: what we?ve learned and what?s to come from testing rapamycin in companion dogs [2:17:30]; Preliminary results of primate studies with rapamycin [2:24:45]; Dosing of rapamycin [2:27:45]; The effect of rapamycin on fertility [2:36:45]; The outlook for future research of rapamycin and the development of rapalogs [2:39:00]; and More.

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In this ?Ask Me Anything? (AMA) episode, Peter dives deep into the critical topic of metabolic disease. He first sheds light on how poor metabolic health drives up the risk of developing other chronic diseases such as cardiovascular disease, cancer, neurodegenerative disease, and overall mortality. He explores the array of metrics and tests used to assess metabolic health, underscoring his preferred methodologies utilized with patients. Finally, Peter provides an overview of the factors one can manipulate in order to improve metabolic health.

If you?re not a subscriber and are listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #51 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Importance of metabolic health and a primer on metabolic disease [1:30]; How poor metabolic health increases one?s risk for other chronic diseases [6:00]; How useful is body weight and BMI for estimating metabolic health? [9:45]; Overview of various tests and metrics used to understand metabolic health [12:15]; Traditional biomarkers and how Peter?s point of view may differ from the guidelines [15:00]; Lactate: insights into metabolic health through fasting and resting lactate levels [17:00]; Zone 2 output: an important functional test of metabolic health [20:00]; Cardiopulmonary exercise testing (CPET) [25:45]; Visceral adipose tissue (VAT): what is VAT and how does it impact health? [27:00]; Oral glucose tolerance test (OGTT): how it works and why it is such an important metric for assessing metabolic health [32:15]; The utility of a continuous glucose monitor (CGM) [40:45]; Liver function and NAFLD [42:15]; Sleep as an intervention [46:00]; Exercise as an intervention [53:15]; Diet and nutrition [59:00]; How reducing stress can improve metabolic health [1:05:15]; and More.

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Andrew Huberman, Professor of Neurobiology at Stanford University and host of the Huberman Lab podcast joins us in a special journal club episode. Peter and Andrew each present a recent paper that sparked their interests, delving into the findings, dissecting their significance, discussing potential confounders and limitations, and exploring remaining questions. Importantly, they share their methodologies for comprehending research studies, providing valuable insights for listeners to navigate this process independently. Peter presents an epidemiological study reevaluating a noteworthy metformin result that intrigued the anti-aging community, leading to discussions on metformin's geroprotective potential (or lack thereof) and the current lack of aging biomarkers. Andrew introduces a paper examining how our beliefs about the medications we take influence their biological effects, distinguishing the "belief effect" from a placebo effect and highlighting its exciting implications for the future.

We discuss:

The motivation behind this journal club conversation [2:45]; Why Peter chose a paper on metformin, how metformin works, and why it generated excitement as a longevity-enhancing agent [9:00]; Defining insulin resistance and its underlying causes [16:15]; Metformin as a first-line treatment for type 2 diabetes, and Peter?s evolving interest in metformin as a geroprotective drug [22:00]; Defining the term ?geroprotection? [24:45]; The 2014 study that got the anti-aging community interested in metformin [26:00]; Peter presents the 2022 paper that repeats the analytical approach from the 2014 Bannister study [33:15]; Greater mortality in the metformin group: how results differed between the 2022 paper and the 2014 paper [40:00]; Understanding statistical significance, statistical power, sample size, and why epidemiology uses enormous cohorts [51:45]; Interpreting the hazard ratios from the 2022 metformin study, and the notable takeaways from the study [56:45]; Drugs that may extend lifespan, why Peter stopped taking metformin, and a discussion of caloric restriction [1:08:45]; Current thoughts on the use of metformin for longevity [1:21:00]; Could there be any longevity benefit to short periods of caloric restriction? [1:22:45]; Peter and Andrew?s process for reading scientific papers [1:26:45]; The biological effects of belief, and how ?belief effects? differ from placebo effects [1:32:30]; The neurobiology of nicotine: a precursor conversation before delving into the paper Andrew chose [1:39:45]; Andrew presents a paper that demonstrates the impact of belief [1:45:30]; Analyzing the fascinating results of the Perl paper [1:54:30]; Exciting implications of the findings about ?belief? reported by Perl and colleagues [2:03:15]; and More.

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This special episode is a rebroadcast of AMA #30, now made available to everyone, in which Peter and Bob Kaplan dive deep into all things related to studying studies to help one sift through the noise to find the signal. They define various types of studies, how a study progresses from idea to execution, and how to identify study strengths and limitations. They explain how clinical trials work, as well as biases and common pitfalls to watch out for. They dig into key factors that contribute to the rigor (or lack thereof) of an experiment, and they discuss how to measure effect size, differentiate relative risk from absolute risk, and what it really means when a study is statistically significant. Finally, Peter lays out his personal process when reading through scientific papers.

We discuss:

The ever-changing landscape of scientific literature [2:30]; The process for a study to progress from idea to design to execution [5:00]; Various types of studies and how they differ [8:00]; The different phases of clinical trials [19:45]; Observational studies and the potential for bias [27:00]; Experimental studies: randomization, blinding, and other factors that make or break a study [44:30]; Power, p-values, and statistical significance [56:45]; Measuring effect size: relative risk vs. absolute risk, hazard ratios, and ?number needed to treat? [1:08:15]; How to interpret confidence intervals [1:18:00]; Why a study might be stopped before its completion [1:24:00]; Why only a fraction of studies are ever published and how to combat publication bias [1:32:00]; Frequency of training for Olympic weightlifting [1:22:15]; How post-activation potentiation (and the opposite) can improve power training and speed training [1:24:30]; The Strongman competition: more breadth of movement, strength, and stamina [1:32:00]; Why certain journals are more respected than others [1:41:00]; Peter?s process when reading a scientific paper [1:44:15]; and More.

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Wendy Chung is a board-certified clinical and molecular geneticist with more than 25 years of experience in human genetic disease research. In this episode, Wendy delves deep into the world of genetics by first exploring the historical landscape of genetics prior to decoding the human genome, contrasting it with what we know today thanks to whole genome and exome sequencing. She provides an overview of genetic testing by differentiating between various genetic tests such as direct-to-consumer, clinical, whole genome sequencing, and more. Additionally, Wendy unravels the genetic underpinnings of conditions such as PKU, breast cancer, obesity, autism, and cardiovascular disease. Finally, Wendy goes in depth on the current state and exciting potential of gene therapy while also contemplating the economic implications and ethical nature of gene editing.

We discuss:

Wendy?s interest in genetics and work as a physician-scientist [2:45]; The genetics of phenylketonuria (PKU), a rare inherited disorder [5:15]; The evolution of genetic research: from DNA structure to whole genome sequencing [18:30]; Insights and surprises that came out of the Human Genome Project [28:30]; Overview of various types of genetic tests: direct-to-consumer, clinical, whole genome sequencing, and more [34:00]; Whole genome sequencing [39:30]; Germline mutations and the implications for older parents [45:15]; Whole exome sequencing and the importance of read depth [50:30]; Genetic testing for breast cancer [54:00]; What information does direct-to-consumer testing provide (from companies like 23andMe and Ancestry.com)? [1:01:30]; The GUARDIAN study and newborn genetic screening [1:06:30]; Treating genetic disease with gene therapy [1:18:00]; How gene therapy works, and the tragic story of Jesse Gelsinger [1:22:00]; Use cases for gene therapy, gene addition vs. gene editing, CRISPR, and more [1:28:00]; Two distinct gene editing strategies for addressing Tay-Sachs and fragile X syndrome [1:37:00]; Exploring obesity as a polygenic disease: heritability, epigenetics, and more [1:41:15]; The genetics of autism [1:48:45]; The genetics of cardiovascular disease [2:01:45]; The financial costs and economic considerations of gene therapy [2:06:15]; The ethics of gene editing [2:12:00]; The future of clinical genetics [2:21:00]; and More.

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Keith Flaherty is the director of clinical research at the Massachusetts General Hospital Cancer Center and a previous guest on The Drive. In this episode, Keith first delves into the statistics on cancer's prevalence as we age, underscoring the significance of finding effective treatments and early detection methodologies. He touches on the history of cancer therapeutics and illuminates the notable enhancements in cancer therapy within the last decade that are setting the stage for a promising future. He goes into detail on the potential of immunotherapy and therapies that can combat cancer?s evasive tactics while explaining some of the existing challenges around specificity, cost, and scalability. Additionally, Keith highlights the significant leap in early detection methodologies, namely liquid biopsies, which have the potential not only to determine if a cancer is present in an early stage, but also identify the possible tissue of origin.

We discuss:

Keith?s interest and expertise in cancer [3:15]; Cancer deaths by decade of life, and how cancer compares to other top causes of death [7:00]; The relationship between hormones and cancer [12:00]; The link between obesity and cancer [18:45]; Current state of treatments for metastatic cancer and reasons for the lack of progress over the decades [22:30]; The interplay between the immune system and cancer cells [32:00]; Different ways cancer can suppress the immune response, and how immunotherapy can combat cancer?s evasive tactics [39:30]; Elimination of a substantial portion of cancers through immune cell engineering faces challenges of specificity, cost, and scalability [52:15]; Why TIL therapy isn?t always effective, and the necessity for multimodal therapy to address various aspects of the cancer microenvironment [1:01:00]; Potential developments in cancer therapy over the next five years: T-cell activation, metabolic interventions, targeting tumor microenvironments, and more [1:06:30]; The challenge of treating metastatic cancer underscores the importance of early detection to improve survivability [1:19:15]; Liquid biopsies for early detection of cancer and determining the possible tissue of origin [1:24:45]; Commercially available cancer screening tests [1:33:45]; How to address the disparity in cancer care, and the exciting pace of progress for cancer detection and treatment [1:40:15]; and More.

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In this "Ask Me Anything" (AMA) episode, Peter delves into the realm of genetics, unraveling its connection to disease and emphasizing the value of understanding one's genetic risks. He elucidates essential background knowledge on genetics before delving into the myriad reasons why individuals might consider genetic testing. Peter differentiates scenarios where genetic testing provides genuine insights from those where it may not be as useful. From there, Peter explores a comprehensive comparison of commercial direct-to-consumer genetic tests, providing insights on interpreting results and identifying the standout options for gaining insights into personal health.

If you?re not a subscriber and are listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #50 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Defining the term ?genetics? and why it?s important [2:15]; What is DNA, and how does it impact our biology and traits? [5:45]; How are genetics passed down from parent to child? [8:45]; How much do genes vary across individuals? [13:00]; Which traits are determined by genetics versus experience or environmental factors? [17:00]; Reasons for genetic testing [22:30]; What exactly is being measured by a genetic test? [29:15]; Testing for monogenic disorders [35:15]; Understanding polygenic risk [39:30]; Is genetic testing more important for someone who doesn?t know their family history? [40:45]; What does it mean to be positive for a particular variant? [43:00]; What does it mean to be negative for a particular variant? [45:45]; How does someone get genetic testing through their healthcare provider, and how are these tests performed? [48:15]; The financial cost of various genetic tests [54:30]; Could having a risk allele for a disease result in an increase in one?s insurance premium? [57:15]; Other risks associated with genetic testing [59:00]; How do commercial, direct-to-consumer genetic tests compare to the information one might receive from clinical genetic testing? [1:01:45]; Are certain direct-to-consumer tests better than others? [1:03:45]; How long until whole genome sequencing becomes genuinely useful? [1:16:00]; How useful are personalized dietary recommendations based on genetics? [1:18:15]; Final thoughts and advice regarding genetic testing [1:20:00]; and More.

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Oliver Burkeman is the author of The New York Times best-seller Four Thousand Weeks: Time Management for Mortals. In this episode, Oliver delves into the pervasive idea that time can be mastered, exploring whether maximizing productivity is an attainable goal or a perpetual trap. He discusses the allure of attempting to control time?and, therefore, the future?and shares his personal journey of experimenting with diverse time management techniques that failed to deliver the emotional satisfaction he sought. Ultimately, they explore the mismatch between being a finite human and existing in a world of infinite possibilities and how all of these concepts intertwine with finding a sense of purpose and meaning. Additionally, Oliver shares insights from his book on productivity, using our time wisely, and embracing our finitude to live a more fulfilling life.

We discuss:

Oliver?s experience that led him to write the book Four Thousand Weeks [3:15]; Human?s relationship with time and the struggle with the finite nature of time [7:15]; How productivity can be a trap [11:00]; The fallacy that being more efficient will open up more time and bring a feeling of control [16:45]; The paradoxical nature of trying too hard to be present in the current moment [22:45]; The value of relationships in meaningful experiences and fulfillment, and how time gets its value from being shared [26:45]; The importance of time synchronicity [36:00]; Identifying your biggest priorities and the paradox of wanting to do more than you have time for [41:00]; Oliver?s moment of clarity in 2014 [47:15]; The role of a sense of purpose in fulfillment [50:15]; Reconciling the finite nature of time and letting go of trying to master your time [59:00]; Why we tend to have a future-focused attitude and how to combat that with atelic activities [1:05:45]; The power of shifting your perspective about time and your experiences [1:12:45]; How to operationalize the three principles for the dilemma of finite time [1:20:15]; Harnessing the power of patience in the face of a problem or experience [1:28:00]; The value of incrementalism for being productive [1:34:15]; Embracing your finitude with curiosity [1:38:00]; Acting on an idea in the moment rather than letting the idea be the obstacle [1:41:15]; and More.

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Adam Cohen is an orthopedic surgeon with expertise in sports medicine. In this episode, Adam breaks down the anatomy of the lower extremities: the hip, knee, ankle, and foot. He explains in detail the common injuries, sources of pain, and what leads to the development of arthritis. He lays out the non-surgical and surgical treatment options as well as the factors that determine whether surgery is appropriate. The discussion includes various procedures like hip replacement, knee replacement, ACL reconstruction, repair of meniscus tears, and more. Additionally, Adam sheds light on the utility of biological therapies like stem cells and platelet-rich plasma (PRP) and how they compare to more traditional approaches.

We discuss:

Anatomy of the hip, hip dysplasia in infants, and the development of arthritis [3:00]; Diagnosing hip pain in people under 50, stress fractures in the femoral neck, and more [11:15]; Common hip injuries, gender differences, and problems that occur when the hip isn?t formed normally [19:30]; Advancements in hip replacement surgery [25:15]; Common hip problems in people over age 60 [27:30]; The importance of muscular strength around the hips for injury prevention [30:30]; Hip fractures due to osteopenia and osteoporosis [36:00]; The utility of biological therapies like stem cells and platelet-rich plasma (PRP) [40:30]; Cortisone as a treatment to delay the need for surgical intervention [53:30]; Anatomy of the knee [56:30]; Are activities like running that amplify forces bad for the knee? [59:45]; Risk of future knee issues and arthritis following an ACL tear or other substantial knee injury [1:04:30]; How the ACL injury happens and how it is repaired [1:08:30]; Arthritis of the knee [1:19:00]; Meniscus tears: how they happen and when surgery is appropriate [1:21:30]; Total knee replacement: when it?s appropriate and how the recovery process compares to hip replacement [1:30:30]; Learning from elite athletes, heart rate recovery, V02 max, and other metrics [1:58:45]; Surgical vs. non-surgical approaches to various knee injuries [1:40:45]; Achilles tendon: tendinitis, rupture of the Achilles tendon, and prevention strategies [1:44:15]; Anatomy of the ankle and foot [1:49:00]; Common injuries to the ankle and foot [1:51:15]; Tips for finding a good orthopedic surgeon [2:01:45]; and More.

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Michael ?Micky? Collins is an internationally renowned expert in sports-related concussions and a consultant for multiple professional sports organizations. In this episode, Mickey first explains the definition and diagnosis of a concussion, as well as the diverse signs and symptoms associated with different types of concussions. He discusses the risk factors that contribute to increased susceptibility and/or severity of concussions in certain individuals, emphasizes the significance of prompt treatment, and uses case studies to illustrate the latest in treatment protocols and recovery process. Additionally, Mickey provides insight into the evolving field of concussion treatments, including the exploration of hyperbaric oxygen and synthetic ketones. He gives advice to parents of kids who play sports and discusses the promising prospects in the realm of concussion management.

We discuss:

Micky?s interest in concussion and how he started the first concussion clinic [3:15]; Concussion: definition, pathophysiology, and risk factors making someone more susceptible [9:45]; Symptoms of concussion, predictors of severity, and the importance of early and effective treatment [20:00]; The six types of concussion, the effectiveness of treatment, and factors that impact recovery [25:45]; The importance of seeing a specialist and the prognosis for recovery [30:00]; Case study of a racecar driver who suffered a vestibular concussion [32:15]; Why vestibular concussions are particularly problematic [42:45]; A treatment plan for the racecar driver, possible use of medications, and how to address the root cause [45:45]; Exploring alternative treatments: hyperbaric oxygen, synthetic ketones, and more [52:00]; The natural history of a concussion if untreated and the effect, if any, of concussion on subsequent risk of brain disease [57:15]; Chronic traumatic encephalopathy (CTE) [1:01:45]; Advice for parents of kids who play sports: when and where to seek treatment for a possible concussion [1:04:45]; Is there any evidence that the APOE4 genotype increases susceptibility to concussion or TBI? [1:10:15]; The increased risk of concussions in older adults and a case study of a 90-year-old patient who suffered a head injury in a fall [1:11:15]; Funding for concussion research and fellowship programs to train concussion specialists [1:15:30]; and More.

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In this "Ask Me Anything" (AMA) episode, Peter goes into depth on the topic of brain health, starting with how Alzheimer's disease is diagnosed, the significance of blood-based biomarkers in diagnosis, and what the various APOE gene variants mean in terms of a person's risk of developing Alzheimer's disease. Next, Peter discusses the various strategies for preventing Alzheimer's disease and neurodegeneration. He touches briefly on exercise as a potent tool, but focuses more on lesser-known factors that could impact brain health, such as nutrition supplementation, lipid management, brain games, sauna, oral health, hearing loss, and more.

If you?re not a subscriber and are listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #49 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Topics: exercise, kidneys, and brain health [1:30]; Rucking: advice for beginners, proper load, packs, and shoes [4:30]; Rucking for women, bone health, using a treadmill, zone 2, and more [11:45]; Building vs. maintaining: when and how to transition from the goal of building muscle and strength to focusing on maintenance [16:00]; Should you lift weights before or after a cardio session? [24:00]; Heart rate recovery: defining heart rate recovery and how it relates to cardiovascular fitness [28:45]; How to measure heart rate recovery, and what is considered a "good" heart rate recovery [33:15]; How kidney health and function typically measured [42:30]; Differentiating between creatine and creatinine [48:15]; The cystatin C blood test as a practical way to assess kidney health [52:45]; How kidney function impacts lifespan and the five stages of kidney disease [59:15]; Slowing the decline of kidney function [1:08:15]; The main drivers of kidney disease [1:11:15]; The importance of managing homocysteine levels for brain health [1:14:00]; The relationship between alcohol consumption and brain health [1:21:30]; and More.

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In this special episode filmed live in front of readers of Outlive, Peter answers questions revolving around his concept of the centenarian decathlon. He starts by defining the ?marginal decade? and how that shapes his training for the events and activities that make up his personal centenarian decathlon. Peter explains how he coaches patients through the challenges of customizing their own list and building out a training plan, including how to set fitness goals early in life in preparation for the marginal decade. From there, he dives into training within the four pillars (zone 2, VO2 max, stability, and strength), including the minimum effective dose, how to split your time, his personal protocols, and other considerations. Additionally, he touches on bone mineral density, female-specific considerations, working through injuries, and the profound impact training can have on the overall quality of life.

We discuss:

The best interventions for longevity [2:15]; The marginal decade and the centenarian decathlon [4:45]; Peter?s personal list of events for his ?centenarian decathlon? and how he helps patients create their own list [8:00]; Determining your fitness goals early in life in preparation for the marginal decade, metrics to track, and more [15:00]; How does playing sports like tennis, basketball, or golf fit into training for the centenarian decathlon? [24:15]; Training within the four pillars: minimum effect dose, how to split your time, and other considerations [27:45]; Advice for the older person and why it?s never too late to start [33:45]; Bone mineral density and other female-specific concerns and considerations [36:15]; Training advice for those with minimal access to a gym or equipment [39:30]; Injuries: prevention and working through existing conditions [41:00]; Cardiorespiratory training: how to split time between zone 2 and VO2 max training, and different modalities for a true zone 2 workout [44:15]; VO2 max training: modalities, Peter?s protocol, and how to monitor progress [54:45]; The profound impact training can have on the overall quality of life [58:15]; 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 [2:45]; How X-ray works, the risk of radiation exposure, and the varying amounts of radiation associated with the different imaging technologies [13:00]; Computed tomography scans (CT scans): The history of CT, how it works, and why we use contrast [22:45]; Ultrasound: Benefits and limitations, and a special use for the heart [36:00]; Detecting breast cancer with mammography: When is works, when you need more testing, and defining ?sensitivity? and ?specificity? [46:15]; Magnetic resonance imaging (MRI): How it works, defining terms, and looking at the most common types of MRI [59:00]; Brain aneurysms: Using MRI to find them and save lives [1:18:45]; Raj?s unique MRI technology [1:25:15]; The risk of false positives in cancer detection, and how Raj?s MRI can reduce the number of false positives (i.e., increase specificity) [1:38:45]; The unique software Raj created to pair with his MRI machine [1:46:15]; Comparing the radiation exposure of a whole-body PET-CT to Raj?s equipment (DWIBS-MRI) [1:48:45]; How diffusion-weighted magnetic resonance imaging (DW-MRI) has revolutionized cancer screening [1:50:15]; Why a DW-MRI is still not a perfect test [1:54:15]; The potential for advancing MRI technology: Where does Raj think it could improve in the next 5-10 years? [1:58:00];/li> Are there any commercially available scanners that can match the resolution of Raj?s images? [2:01:00]; Machine learning: When and where might machine learning/AI impact the field of radiology? [2:03:45]; and More.

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Mohit Khera is a world-renowned urologist with expertise in sexual medicine and testosterone therapy. In this episode, Mohit provides a comprehensive overview of male sexual health. He begins with an in-depth exploration of erectile dysfunction, shedding light on its prevalence across different age groups, diagnostic methods, and its intriguing connection to cardiovascular disease. He then ventures into Peyronie's disease, penile fractures, penile enlargement treatments, prolonged erections, premature ejaculation, and anorgasmia. Shifting gears, Mohit delves into the intricate workings of testosterone, DHT, and estrogen, emphasizing their physiological significance and interplay. He explains blood tests for diagnosing low testosterone, the correlation between symptoms and blood levels in cases of low testosterone, and the pros and cons of different methodologies for increasing testosterone. He concludes with a thought-provoking conversation about the role of testosterone in patients with prostate cancer and addresses concerns surrounding DHT, finasteride, and post-finasteride syndrome.

We discuss:

Mohit?s career path and interest in sexual medicine and infertility [3:00]; The anatomy of the male genitalia [5:45]; The prevalence of sexual dysfunction, its impact on quality of life, and the importance of seeking help [7:15]; Erectile dysfunction (ED): definition, diagnosis, pathophysiology, and more [11:00]; The history of medications to treat ED and the mechanisms of how they work [15:30]; Relationship between aging and erectile dysfunction and Mohit's approach to treating patients and prescribing medications [20:00]; The impact of lifestyle on sexual health and the association between ED and cardiovascular disease [29:30]; Causes and treatments for Peyronie?s Disease, penile fracture, and more [37:30]; The value of ultrasound for ED diagnosis and management strategies [47:45]; Various treatment options for ED: injections, penile prosthesis, and more [50:15]; Priapism (prolonged erection): what is happening and when to seek treatment [57:15]; Shockwave therapy as a treatment for ED [1:02:45]; Stem cell therapy for ED [1:08:15]; Platelet-rich plasma (PRP) injections as a treatment for ED [1:12:00]; Premature ejaculation (PE): prevalence, pathophysiology, and treatment [1:14:45]; Anorgasmia: causes and treatment [1:22:00]; The interplay of sex hormones, the impact of aging, symptoms of low testosterone, and considerations for testosterone replacement therapy (TRT) [1:26:45]; Methods for increasing endogenous testosterone [1:38:45]; Testosterone replacement therapy: various forms of exogenous testosterone, weighing risk vs. reward, and more [1:52:30]; The physiology and purpose of testosterone and DHT, why some men feel fine even with ?low? testosterone, personalized approaches to treating low testosterone, and more [2:02:30]; Post-finasteride syndrome [2:09:00]; The role of testosterone in prostate cancer and addressing the notion that TRT could increase risk [2:16:15]; The effects of testosterone as an adjunct to therapy for estrogen-sensitive breast cancer in women [2:27:15]; Resources for those looking for healthcare providers [2:28:45]; and More.

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Sharon Parish is a Professor of Medicine in Clinical Medicine and Clinical Psychiatry at Weill Cornell Medical College and a prominent sexual medicine specialist who has been practicing for 30 years. In this episode, Sharon tackles the topic of women's sexual health, including the conditions associated with decreased sexual function and desire and available treatment options. She explores the influence of sexual health on overall well-being while also examining the potential effects of childbirth, birth control, metabolic health, and more on sexual function and desire. Through case studies, Sharon teases apart the differences between desire and arousal, explains the various factors that affect them, and walks through hypothetical treatment plans for the case study patients. In addition, she delves into the subject of menopause, addressing its impact on sexual health as well as the misguided fears around hormone replacement therapy. Stay tuned for next week's launch of our complementary podcast on men's sexual health.

We discuss:

Sharon's interest in sexual medicine and the current state of the field [3:00]; How hormones change in women over time and how that impacts sexual function [8:15]; Changes after childbirth and its impact on sexual function [11:00]; The role of metabolic health and systemic vascular health in sexual health [20:15]; Conditions associated with decreased sexual function and the importance of sexual health for overall wellbeing [26:15]; Sexual dysfunction case study #1: A 41-year-old mother of two, the sexual response cycle, and the difference between arousal and desire [38:45]; Medications that may reduce sexual desire [49:45]; The effect of birth control pills on sexual desire [56:30]; The importance of testosterone in women for sexual function and desire, and why the FDA hasn't approved exogenous testosterone as a therapeutic [1:01:15]; Challenges faced by physicians who are open to prescribing off-label testosterone for women, and Sharon's approach in managing this aspect with her patients [1:14:30]; A hypothetical treatment plan for the patient in case study #1 [1:26:45]; The role of DHEA (a precursor to testosterone) in female sexual health [1:32:15]; Case study #2: A 30-year-old woman with anorgasmia (inability to orgasm) [1:38:30]; Resources for helping women and their partners to enhance the pleasure experienced during sex, overcome anxiety, and increase desire [1:51:30]; Two drugs for premenopausal women with low desire [1:59:30]; Why treatments are potentially underutilized for both desire and genitourinary syndrome of menopause [2:13:15]; Case study #3: A menopausal woman with symptoms [2:19:00]; Addressing the misguided fears around hormone replacement therapy and cancer [2:24:15]; Symptoms and treatment of genitourinary syndrome of menopause [2:32:45]; Age 65 and beyond, and resources for finding a provider [2:37:30]; and More.

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In this ?Ask Me Anything? (AMA) episode, Peter delves into the critical subject of blood pressure, which is one of the three primary causes of atherosclerosis, along with high apoB and smoking. He begins by unraveling the nature of high blood pressure, its prevalence, and why it often goes undiagnosed. Peter describes in detail the proper way to accurately measure blood pressure and what determines a diagnosis. Next, Peter discusses the actionable steps one can take in response to high blood pressure, shedding light on the extent to which factors like weight loss, exercise, and nutrition can make an impact. He also explores the pharmacological options available and offers valuable insights on how to approach them.

If you?re not a subscriber and are listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #48 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Blood pressure and other risk factors for cardiovascular disease [2:30]; Defining blood pressure and the purpose and meaning of a blood pressure measurement [5:45]; The implications of high blood pressure and the importance of maintaining an optimal level [10:30]; The importance of accurate measurements of blood pressure and how Peter approaches the care of patients at the very top range of ?normal? [21:45]; The prevalence of high blood pressure?a hidden epidemic? [24:30]; The consequences of high blood pressure on cardiovascular health, brain health, kidneys, and more [27:45]; Low blood pressure: symptoms and consequences [35:30]; How to properly measure blood pressure [37:45]; Daily variance in blood pressure and the transient changes in blood pressure during exercise [48:00]; Primary hypertension vs. secondary hypertension: what to look for [51:45]; Lifestyle factors impacting blood pressure: weight loss, exercise, and sodium [57:45]; Impact of insulin resistance and type 2 diabetes on blood pressure [1:04:45]; How sleep impacts blood pressure [1:06:45]; Pharmacologic options for managing blood pressure [1:08:00]; and More.

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Tommy Wood is an Assistant Professor of Pediatrics at the University of Washington, where he studies brain injury and how lifestyle choices and environmental factors contribute to brain health, cognitive function, and chronic disease. In this episode, Tommy delves into the complexities of age-related cognitive decline and explores interventions to counteract it. Drawing from his experience working with Formula 1 drivers, he highlights the connection between cognitive function and the right type of demands and training leading to improvement. Next, he explores the various theories on the different types of pathology in dementia and neurodegeneration. He makes the case that a large fraction of dementia is preventable through lifestyle choices and nutrient status, and provides an in-depth overview of interventions and supplements that support cognitive function. Finally, he provides a comprehensive overview of head injuries, including concussions and traumatic brain injuries (TBIs), discussing symptoms, how to mitigate damage following an incident, and long-term management.

We discuss:

Tommy?s professional work, unique skill sets, and interests [3:00]; Age-related decline in cognitive function and memory [5:45]; Improving brain function with the right level and type of demand [20:15]; Formula 1 as a model for how to perform under high cognitive demand and how to increase multitasking capacity [31:30]; Advice for the person reaching middle life looking to mitigate cognitive decline [37:45]; Tasks and activities that support and improve cognitive function [45:30]; Neuropathology of Alzheimer?s disease: exploring the role of amyloid and tau proteins [49:30]; Why Tommy believes dementia research funding should be focused on environmental and lifestyle-based risk factors [1:05:15]; Benefits of lowering homocysteine and boosting omega-3?s, and evidence-based supplements that support cognitive function [1:09:00]; A unifying theory of dementia [1:20:45]; How muscular strength can help with both the prevention and survivability of dementia [1:24:15]; Head injuries: comparing concussions against traumatic brain injuries (TBIs), mitigating the damage after an incident, and the long-term management of head injuries [1:29:15]; Is hyperbaric oxygen treatment helpful after a TBI? [1:45:45]; Supplements that aid recovery from a TBI: creatine, DHA, and choline [1:49:30]; Demands faced by F1 drivers, and testing interventions to improve their performance [1:57:30]; and More.

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In this special episode of The Drive, Peter provides a comprehensive overview of the various endocrine systems: the thyroid system, the adrenal system, and the sex hormone system (for both men and women). He walks through the basic biology and the feedback cycles that regulate the production of these hormones and discusses the various options for the treatment of hormone deficiencies. In addition, Peter delves into hormone replacement therapy (HRT), providing nuanced insights into its appropriate usage and the clinical approach he adopts when working with patients.

 

Peter supplements these explanations with whiteboard illustrations. For a more complete understanding, we highly recommend watching these videos over just listening. The videos can be found on our YouTube channel or on the show notes page.

We discuss:

The thyroid system [2:15]; The adrenal system [15:45]; The female sex hormone system [27:00]; The male sex hormone system [40:00]; and More.

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John Kastelein is a renowned expert in lipoprotein metabolism and atherosclerotic cardiovascular disease (ASCVD) research. In this discussion, John delves deep into familial hypercholesterolemia (FH), a genetic disorder characterized by high levels of LDL cholesterol in the blood that increases the risk of developing heart disease. He covers its definition, genetic underpinnings, and clinical identification. He then explores the therapeutic options available for the prevention and treatment of cardiovascular disease, including the captivating history of CETP inhibitors. He explains the past shortcomings of previous CETP inhibitors before underscoring the compelling potential of the latest iterations, not only for cardiovascular disease but also for conditions like Alzheimer's disease and type 2 diabetes. Moreover, he unveils the intricate role of APOE, shedding light on why the APOE4 isoform codes for a protein that significantly increases the risk of Alzheimer's disease and cardiovascular disease. Concluding the discussion, John shares a profound sense of optimism, envisioning the possibility of targeted therapeutic interventions for high-risk patients in the near future.

We discuss:

Familial hypercholesterolemia (FH): a genetic condition [4:30]; Differentiating between phenotype and genotype when it comes to FH [9:45]; The pathophysiology related to mutations of FH [15:30]; Clinical presentations, physical manifestations, and diagnosis of FH [22:00]; Why a small fraction of people with FH do not develop premature ASCVD [34:15]; Treatment and prevention for those with FH [39:45]; Addressing the assertion by some that elevated LDL is not casual in cardiovascular disease [52:45]; The history of CETP inhibitors, and the role of the CETP protein [55:45]; The thrifty gene hypothesis and why genes underlying FH may have been preserved [1:09:00]; The compelling potential of the latest CETP inhibitor (obicetrapib) [1:13:00]; Promising results from phase 3 trials exploring obicetrapib [1:27:45]; Why the APOE4 allele increases the risk of Alzheimer?s disease, and the connection to blood lipids [1:41:30]; The role of APOE in cardiovascular disease [1:51:45]; Takeaways and looking ahead [1:57:00]; and More.

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In this ?Ask Me Anything? (AMA) episode, Peter delves deep into the data surrounding different forms of cold therapy, including cold water immersion, cryotherapy, and cold showers, aiming to unveil the potential benefits and drawbacks associated with cold therapy. He dissects the studies examining the effects of cold therapy on delayed onset muscle soreness (DOMS), activation of brown adipose tissue, and its potential impact on mood and as a therapeutic approach for depression. Furthermore, Peter discusses the potential negative impact cold therapy may have on muscular hypertrophy and offers his perspective on the extent to which the data support the notion of cold therapy providing longevity benefits. Finally, he also discusses the existing consensus, or lack thereof, regarding the optimal structure of an effective cold therapy protocol.

If you?re not a subscriber and are listening on a podcast player, you?ll only be able to hear a preview of the AMA. If you?re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #47 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Overview of discussion on cold therapy (and a Formula 1 tangent) [1:45]; The most common cold exposure therapies [5:45]; Potential benefits of cold water immersion: a look at the data [9:30]; Comparing the effects of cold water immersion with whole-body cryotherapy [18:30]; The potential impact of cold exposure on mood and as a treatment for depression [20:45]; How do cold showers compare to cold water immersion? [28:15]; Cold exposure and the activation of brown adipose tissue (BAT) [34:15]; Things that clearly impact brain health: smoking, alcohol, sleep, head injuries, blood pressure, and more [34:15]; Exercising in cold temperatures: impact on exercise performance [38:30]; Potential downsides of cold therapy and its impact on hypertrophy, strength, and recovery [44:45]; Are the blunting effects of cold on hypertrophy due to the effects on inflammation? [50:45]; Does cold exposure offer any potential geroprotective benefits? [53:15]; Cold therapy protocols for delayed onset muscle soreness (DOMS) [56:30]; Summarizing the data and takeaways from Peter [1:01:00]; and More.

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JoAnn Manson is a world-renowned endocrinologist, epidemiologist, and Principal Investigator for the Women?s Health Initiative (WHI). In this episode, she dives deep into the WHI to explain the study design, primary outcome, confounding factors, and nuanced benefits and risks of hormone replacement therapy (HRT). JoAnn reflects on how a misinterpretation of the results, combined with sensationalized headlines regarding an elevated risk of breast cancer, led to a significant shift in the perception and utilization of HRT. From there, they take a closer look at the breast cancer data to separate fact from fiction. Additionally, JoAnn gives her take on how one should weigh the risks and benefits of HRT and concludes with a discussion on how physicians can move towards better HRT practices.

We discuss:

The Women?s Health Initiative: the original goal of the study, hormone formulations used, and potential confounders [4:15]; Study design of the Women?s Health Initiative, primary outcome, and more [16:00]; JoAnn?s personal hypothesis about the ability of hormone replacement therapy to reduce heart disease risk prior to the WHI [26:45]; The relationship between estrogen and breast cancer [30:45]; Why the WHI study was stopped early, and the dramatic change in the perception and use of HRT due to the alleged increase in breast cancer risk [37:30]; What Peter finds most troubling about the mainstream view of HRT and a more nuanced look at the benefits and risks of HRT [45:15]; HRT and bone health [56:00]; The importance of timing when it comes to HRT, the best use cases, and advice on finding a clinician [59:30]; A discussion on the potential impact of HRT on mortality and a thought experiment on a long-duration use of HRT [1:03:15]; Moving toward better HRT practices, and the need for more studies [1:10:00]; and More.

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Rhonda Patrick, Ph.D., is a scientist with expertise in the areas of aging, cancer, and nutrition who translates complex scientific topics into actionable insights on her podcast, Found My Fitness. In this episode, Rhonda provides her latest thinking as it relates to Alzheimer's disease including the possibility of a vascular hypothesis as well as the factors that can impact disease risk such as type 2 diabetes, blood pressure, omega supplementation, exercise, sauna, and more. She also touches on cancer risk including the relationship between cancer and exercise as well as the link between alcohol consumption and cancer. Additionally, Rhonda explains her new focus on exercise and protein consumption as well as how her perspective has shifted as it pertains to fasting and time-restricted feeding.

We discuss:

Alzheimer?s disease: Rhonda?s evolved thinking on neurodegenerative diseases [2:30]; The breakdown of the blood-brain barrier in neurodegenerative disease [8:45]; An explanation for the observation that type 2 diabetes increases risk of Alzheimer?s disease [15:45]; The role of omega-3 fatty acids (EPA and DHA) in brain health and prevention of neurodegeneration [19:45]; Comparing the preventable nature of type 2 diabetes, atherosclerosis, cancer, and dementia [32:15]; Blood pressure: an important modifiable lifestyle factor that can affect Alzheimer's disease risk [35:15]; Rhonda?s outlook on ?precision medicine? as it pertains to one?s genetic predispositions [38:45]; Possible mechanisms by which exercise reduces the risk of Alzheimer?s disease [45:45]; Building your aerobic pyramid: neurobiological effects of exercise, benefits of lactate peaks, and more [53:45]; Maximizing mitochondrial biogenesis: alternative training approaches and strategies [58:45]; Possible brain benefits of sauna, and Rhonda?s personal protocol [1:09:30]; The relationship between cardiorespiratory fitness and dementia risk [1:15:30]; How exercise may reduce the risk of cancer [1:20:30]; The overarching impact of exercise on health, and the importance of focusing the factors that matter most [1:33:15]; Impact of alcohol consumption on breast cancer risk and overall health [1:37:15]; Exercise as an intervention for poor sleep habits [1:42:30]; The longevity benefits of consuming adequate protein and strength training to preserve muscle mass and strength [1:46:30]; How to get enough of the right kind of protein in your diet [2:05:15]; Fasting: weighing the risk vs. reward [2:12:15]; How Rhonda?s views have shifted on diet and exercise [2:15:30]; How to follow Rhonda?s work and more about the benefits of lactate for the brain [2:21:00]; and More.

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