#325 ‒ Peter’s key takeaways on bone health, calorie restriction and energy balance, dopamine and addiction, gene editing, and testosterone therapy safety with a prostate cancer diagnosis | Quarterly Podcast Summary #3

The Peter Attia Drive

View the Show Notes Page for This Episode

31:01

National Geographic photographer and conservationist Jaime Rojo has spent decades capturing the beauty and fragility of the monarch butterfly. Their epic migration is one of nature’s most breathtaking spectacles, but their survival is under threat. In this episode, Jaime shares how his passion for photography and conservation led him to document the monarchs’ journey. He and host Brian Lowery discuss the deeper story behind his award-winning images, one about resilience, connection, and the urgent need to protect our natural world. See Jaime's story on the monarch butterflies at his website: rojovisuals.com , and follow Brian Lowery at knowwhatyousee.com .…

about a year ago 25:02

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In this quarterly podcast summary (QPS) episode, Peter summarizes his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from his discussions on diverse topics such as dopamine and addiction with Anna Lembke, the current state and exciting future of CRISPR-mediated gene editing with Feng Zhang, how to build and maintain strong bones from youth to old age with Belinda Beck, how calorie restriction may influence longevity and metabolic health with Eric Ravussin, and the role of testosterone and TRT in prostate cancer with Ted Schaeffer. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these engaging discussions.

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 episode #325 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

Overview of topics to be covered [1:45];
Anna Lembke episode: addiction, dopamine's role in pleasure and pain, and managing addictive behaviors [4:15];
Follow-up questions about addiction: heritability, cold therapy, exercise, and strategies for breaking addictive behaviors [14:45];
Feng Zhang episode: the potential of gene editing with CRISPR technology for treating diseases, and the challenges ahead [21:00];
Feng Zhang’s impactful education experience, and how early exposure and curiosity-driven learning can develop scientific interest for kids [28:30];
The future of CRISPR: weighing the scientific potential to combat complex diseases against ethical considerations around genetic modification [33:45];
Belinda Beck episode: how to build and maintain strong bones from youth to old age [37:30];
How both nutrition and exercise are crucial for bone health at all ages, and why it’s never too late to start [54:45];
Eric Ravussin episode: calorie restriction, energy expenditure, exercise for weight maintenance, and more [59:00];
Measuring energy intake and energy expenditure: techniques and challenges [1:09:45];
ed Schaeffer episode: the nuance role of testosterone in prostate cancer, TRT, and the need for better cancer biomarkers [1:14:30];
Peter’s favorite bands [1:25:45]; and
More.

Connect With Peter on Twitter, Instagram, Facebook and YouTube

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#Medicine #Peter Attia, MD #Peter Attia #Fitness #Health and Well-Being #Exclusive Podcast Content

#325 ‒ Peter’s key takeaways on bone health, calorie restriction and energy balance, dopamine and addiction, gene editing, and testosterone therapy safety with a prostate cancer diagnosis | Quarterly Podcast Summary #3

The Peter Attia Drive

1,089 subscribers

published about a year ago

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MP3•एपिसोड होम

View the Show Notes Page for This Episode

Become a Member to Receive Exclusive Content

We discuss:

Overview of topics to be covered [1:45];
Anna Lembke episode: addiction, dopamine's role in pleasure and pain, and managing addictive behaviors [4:15];
Follow-up questions about addiction: heritability, cold therapy, exercise, and strategies for breaking addictive behaviors [14:45];
Feng Zhang episode: the potential of gene editing with CRISPR technology for treating diseases, and the challenges ahead [21:00];
Feng Zhang’s impactful education experience, and how early exposure and curiosity-driven learning can develop scientific interest for kids [28:30];
The future of CRISPR: weighing the scientific potential to combat complex diseases against ethical considerations around genetic modification [33:45];
Belinda Beck episode: how to build and maintain strong bones from youth to old age [37:30];
How both nutrition and exercise are crucial for bone health at all ages, and why it’s never too late to start [54:45];
Eric Ravussin episode: calorie restriction, energy expenditure, exercise for weight maintenance, and more [59:00];
Measuring energy intake and energy expenditure: techniques and challenges [1:09:45];
ed Schaeffer episode: the nuance role of testosterone in prostate cancer, TRT, and the need for better cancer biomarkers [1:14:30];
Peter’s favorite bands [1:25:45]; and
More.

Connect With Peter on Twitter, Instagram, Facebook and YouTube

386 एपिसोडस

#Medicine #Peter Attia, MD #Peter Attia #Fitness #Health and Well-Being #Exclusive Podcast Content

Todos los episodios

1
#337 - Insulin resistance masterclass: The full body impact of metabolic dysfunction and prevention, diagnosis, and treatment | Ralph DeFronzo, M.D. 2:26:40

6 days ago2:26:40

2:26:40

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Ralph DeFronzo is a distinguished diabetes researcher and clinician whose groundbreaking work on insulin resistance has reshaped the understanding and treatment of type 2 diabetes. In this episode, Ralph shares insights from his five decades of research, including his pivotal role in bringing metformin to the U.S. and developing SGLT2 inhibitors. Ralph explores the impacts of insulin resistance on specific organs, the pharmacologic interventions available, and the gold-standard euglycemic clamp method for measuring insulin resistance. This episode is a masterclass in the pathophysiology and treatment of type 2 diabetes, featuring an in-depth discussion of GLP-1 receptor agonists, metformin, and a lesser-known class of drugs that opened Peter’s eyes to new possibilities in diabetes care. We discuss: Metabolic disease as a foundational driver of chronic illness [4:00]; Defining insulin resistance: effects on glucose, fat, and protein metabolism, and how it varies between healthy, obese, and diabetic individuals [8:15]; The historical significance of the development of the euglycemic clamp technique for measuring insulin resistance [11:45]; How insulin affects different tissues: liver, muscle, and fat cells [15:00]; The different ways insulin resistance manifests in various tissues: Alzheimer’s disease, cardiovascular disease, and more [25:00]; The dangers of hyperinsulinemia, and the importance of keeping insulin levels within a physiological range [29:00]; The challenges of identifying the genetic basis of insulin resistance and type 2 diabetes [37:00]; The “ominous octet”—a more comprehensive model of type 2 diabetes than the traditional triumvirate [45:45]; The kidneys’ unexpected role in worsening diabetes, and how SGLT2 inhibitors were developed to treat diabetes [55:45]; How insulin resistance in the brain and neurocircuitry dysfunction contribute to overeating and metabolic disease [1:04:15]; Lipotoxicity: how overeating fuels insulin resistance and mitochondrial dysfunction [1:07:30]; Pioglitazone: an underappreciated and misunderstood treatment for insulin resistance [1:10:15]; Metformin: debunking the misconception that it is an insulin sensitizer and explaining its true mechanism of action [1:19:15]; Treating diabetes with triple therapy vs. the ADA approach: a better path for diabetes management [1:24:00]; GLP-1 agonists, the Qatar study, and rethinking diabetes treatment [1:31:30]; Using a hyperglycemic clamp to look for genes that cause diabetes [1:45:15]; The superiority of measuring C-peptide instead of insulin to assess beta-cell function [1:46:45]; How GLP-1-induced weight loss affects muscle mass, the benefits and risks of myostatin inhibitors, and the need for better methods of evaluating functional outcomes of increased muscle mass [1:51:30]; The growing crisis of childhood obesity and challenges in treating it [2:02:15]; The environmental and neurological factors driving the obesity epidemic [2:07:30]; The role of genetics, insulin signaling defects, and lipotoxicity in insulin resistance and diabetes treatment challenges [2:11:00]; The oral glucose tolerance test (OGTT): detecting early insulin resistance and beta cell dysfunction [2:18:30]; and More. Connect With Peter on Twitter , Instagram , Facebook and YouTube…

1
#336 - AMA #68: Fasting, well-balanced diets, alcohol, exercise for busy people, wearables, emotional health, assessing cardiovascular health, and more 27:29

13 days ago27:29

27:29

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter tackles a diverse set of listener-submitted questions, covering a wide range of health and performance topics. He dives into assessing cardiovascular health, discussing key biomarkers and risk factors, and breaks down various fasting approaches, including time-restricted eating and prolonged fasting. The conversation also explores the impact of alcohol on health and disease risk, fundamental principles of nutrition, and optimal protein intake. Additionally, he examines the pros and cons of ketogenic and low-carb diets, strategies for building effective exercise routines, and the role of wearables in tracking health metrics. The episode concludes with insights on emotional health, making this a well-rounded discussion packed with practical takeaways for anyone looking to optimize their well-being. 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 #68 show notes page . If you are not a subscriber, you can learn more about the subscriber benefits here . We discuss: Episode format: overview of common health topics based on listener questions [1:30]; How to accurately assess your cardiovascular health [3:00]; The impact of fasting, time-restricted eating, and dietary restriction on metabolic health [9:00]; Alcohol: health risks of consumption, limitations of research, and how to weigh the risks against social and personal enjoyment [13:45]; Principles of a well-balanced diet: macronutrients, micronutrients, protein, energy balance, and more [23:45]; The benefits and drawbacks of ketogenic diets: impact on satiety, metabolic health, athletic performance, lipid levels, and more [29:15]; Protein: best sources for muscle growth, total intake, PDCAAS scoring system, and getting adequate amounts on plant-based diets [36:15]; Creating an effective fitness routine that fits into a busy schedule [41:45]; The role of rest and recovery in a workout routine [46:00]; How to track fitness progress beyond just weight on a scale [48:30]; The best low-impact exercises for individuals with joint issues [52:00]; Wearables: insight vs. compliance, and how to use them effectively [54:45]; How to evaluate the risks and benefits of medical interventions: procedural risks, complication rates, and asking informed questions [59:00]; Sleep: impact on metabolic and cognitive health, and tips for improving sleep quality [1:03:45]; How to identify and address emotional health challenges [1:08:30]; and More. Connect With Peter on Twitter , Instagram , Facebook and YouTube…

1
#335 ‒ The science of resistance training, building muscle, and anabolic steroid use in bodybuilding | Mike Israetel, Ph.D. 2:51:18

20 days ago2:51:18

2:51:18

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Mike Israetel is a sports physiologist, competitive bodybuilder, and co-founder of Renaissance Periodization, where he coaches athletes and professionals in diet and weight training. In this episode, Mike shares his journey from powerlifting to academia, breaking down the core principles of resistance training, including exercise selection, volume, intensity, and frequency. He debunks common misconceptions about strength training, explains how to structure an effective program for beginners and advanced lifters, and provides candid insights into his experience with anabolic steroids, discussing their effects on muscle growth, performance, and health risks. This conversation offers a deep dive into the science of building muscle, the realities of bodybuilding at the highest levels, and explores the potential of AI-driven breakthroughs to advance human performance and longevity. We discuss: Mike’s academic journey, and early experiences in powerlifting, personal training, and sports physiology [3:30]; Mike’s transition from powerlifting to bodybuilding, and his scientific and artistic approach to sculpting muscle and optimizing aesthetics [9:15]; The value of strength training, time efficiency, and how it differs from endurance training [14:45]; Neurological fatigue in strength training: balancing recovery and pushing the limits [26:15]; The relationship between training intensity and volume, why muscle growth is not linear, and how different approaches affect results [35:00]; Sustainable and effective approaches to maximizing muscle growth: training close to failure while minimizing fatigue [40:00]; An efficient and effective resistance training program for beginners with limited time [49:00]; Advice for finding a good trainer [1:06:30]; Troubleshooting training plateaus: optimizing exercise selection, intensity, and recovery for muscle growth [1:13:30]; The impact of genetics, age, and lifestyle on muscle growth [1:27:45]; The importance of nutrition, protein intake, and consistency in both training and diet for muscle growth [1:31:00]; The use of anabolic steroids to boost muscle growth: doses, drug combinations, and side effects [1:35:45]; Long-term impact of steroid use: muscle retention, genetics and individual variability, and impact after discontinuation [1:52:15]; Trade-offs of long-term usage of supraphysiologic doses of testosterone: health, performance, and Mike’s future plans [2:00:45]; The potential for AI-driven medical breakthroughs to reverse aging and disease [2:07:30]; The role of AI in accelerating drug development, advancing human longevity, and overcoming biological limitations [2:19:45]; The philosophical implications of simulated reality, the impact of robotics on human labor and economics, and the challenge of predicting the future [2:25:15]; Would having kids change Mike’s philosophy around anabolic steroid use? [2:32:15]; The role of GLP-1 agonists in bodybuilding and general weight management, and the moral and philosophical debates surrounding their use [2:35:45]; and More. Connect With Peter on Twitter , Instagram , Facebook and YouTube…

1
#334 - Cardiovascular disease, the number one killer: development, biomarkers, apoB, cholesterol, brain health, and more | Tom Dayspring, M.D. 2:17:37

27 days ago2:17:37

2:17:37

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Tom Dayspring is a world-renowned expert in clinical lipidology and a previous guest on The Drive. In this episode, Tom explores the foundations of atherosclerosis and why atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide for both men and women. He examines how the disease develops from a pathological perspective and discusses key risk factors, including often-overlooked contributors such as insulin resistance and chronic kidney disease. He breaks down the complexities of cholesterol and lipoproteins—including LDL, VLDL, IDL, and HDL—with an in-depth discussion on the critical role of apolipoprotein B (apoB) in the development of atherosclerosis. Additionally, he covers the importance of testing various biomarkers, the impact of nutrition on lipid levels, and the vital role of cholesterol in brain health, including how cholesterol is synthesized and managed in the brain, how it differs from cholesterol regulation in the rest of the body, and how pharmacological interventions can influence brain cholesterol metabolism. We discuss: Defining atherosclerotic cardiovascular disease (ASCVD): development, risks, and physiological impact [2:45]; The pathogenesis of ASCVD: the silent development over decades, and the importance of early detection for prevention of adverse outcomes [10:45]; Risk factors versus risk markers for ASCVD, and how insulin resistance and chronic kidney disease contribute to atherosclerosis [17:30]; How hyperinsulinemia elevates cardiovascular risk [24:00]; How apoB-containing lipoproteins contribute to atherosclerosis, and why measuring apoB is a superior indicator of cardiovascular risk compared to LDL cholesterol [29:45]; The challenges of detecting early-stage atherosclerosis before calcification appears [46:15]; Lp(a): structure, genetic basis, and significant risks associated with elevated Lp(a) [55:30]; How aging and lifestyle factors contribute to rising apoB and LDL cholesterol levels, and the lifestyle changes that can lower it [59:45]; How elevated triglycerides, driven by insulin resistance, increase apoB particle concentration and promote atherosclerosis [1:08:00]; How LDL particle size, remnant lipoproteins, Lp(a), and non-HDL cholesterol contribute to cardiovascular risk beyond apoB levels [1:21:45]; The limitations of using HDL cholesterol as a marker for heart health [1:29:00]; The critical role of cholesterol in brain function and how the brain manages its cholesterol supply [1:36:30]; The impact of ApoE genotype on brain health and Alzheimer's disease risk [1:46:00]; How the brain manages cholesterol through specialized pathways, and biomarkers to track cholesterol health of the brain [1:50:30]; How statins might affect brain cholesterol synthesis and cognitive function, and alternative lipid-lowering strategies for high-risk individuals [1:57:30]; Exciting advancements in therapeutics, diagnostics, and biomarkers coming in the next few years [2:09:30]; Recent consensus statements on apoB and Lp(a) from the National Lipid Association (NLA) [2:12:30]; and More. Connect With Peter on Twitter , Instagram , Facebook and YouTube…

1
#333 ‒ Longevity roundtable — the science of aging, geroprotective molecules, lifestyle interventions, challenges in research, and more | Steven Austad, Matt Kaeberlein, Richard Miller 2:41:39

5 weeks ago2:41:39

2:41:39

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this special episode of The Drive, Peter introduces a brand-new roundtable format. Joined by three renowned experts in longevity science—Steven Austad, Richard Miller, and Matt Kaeberlein—the group explores the rapidly evolving field of geroscience. Together, they dive deep into topics like the relationship between healthspan and lifespan, evaluating interventions like rapamycin and senolytics, the role of epigenetic changes in aging, and whether GLP-1 receptor agonists hold geroprotective potential. They also tackle major challenges in funding and public acceptance of longevity research including how geroprotective interventions might be tested in humans. Packed with nuanced debate, humor, and groundbreaking insights, this episode is a must-listen for anyone fascinated by the science of aging. We discuss: The recent rise in public interest in longevity, misconceptions, and the link between healthspan and lifespan [3:45]; Redefining healthspan, the US healthcare paradox, and separating longevity science from commercial hype [12:30]; The need to redirect medical research from disease-specific models to aging-focused approaches [21:30]; Proactive healthcare: rethinking health, disease, and the role of aging [30:00]; Biologic age versus chronologic age, and the limitations and potential of epigenetic clocks [35:00]; The utility and drawbacks of the “hallmarks of aging” as a framework for research and funding [49:30]; The role of epigenetic changes in aging and the challenges of proving causality [56:45]; The translational challenges of moving aging research from preclinical studies to human applications [1:03:45]; Distinguishing between a biomarker of aging and aging rate indicators [1:17:15]; The difficulties of translating longevity research in mice to humans, and the difficulties of testing interventions in humans [1:21:15]; Exercise, aging, and healthspan: does exercise slow aging? [1:35:45]; Are GLP-1 receptor agonists geroprotective beyond caloric restriction effects? [1:41:00]; The role of senescent cells in aging, challenges with reproducibility in studies, and differing views on the value of current research approaches [1:46:15]; How funding challenges and leadership in NIH and other institutes impact the advancement of aging-related research [2:00:15]; Metformin: geroprotective potential, mechanisms, and unanswered questions [2:02:30]; Canagliflozin and rapamycin as geroprotective molecules: mechanisms, dosing strategies, and longevity potential [2:10:45]; Resveratrol and NAD precursors—a lack of evidence for anti-aging effects [2:22:45]; The potential of parabiosis and plasmapheresis to slow aging, the challenges in translating mouse studies to humans, and possible design for human studies [2:29:45]; and More. Connect With Peter on Twitter , Instagram , Facebook and YouTube…

1
#332 - AMA #67: Microplastics, PFAS, and phthalates: understanding health risks and a framework for minimizing exposure and mitigating risk 25:21

6 weeks ago25:21

25:21

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter tackles a topic that's been dominating headlines and sparking widespread concern: microplastics and plastic-associated chemicals, including BPA, PFAS, and phthalates. Peter explores the science behind these substances including how and why they've become so prevalent, the extent of our exposure, and the potential risks to our health. Most importantly, he provides a practical framework for understanding microplastics and plastic-associated chemicals and minimizing exposure while distinguishing genuine risks from exaggerated concerns. 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 #67 show notes page . If you are not a subscriber, you can learn more about the subscriber benefits here . We discuss: The complexity of the topic of microplastics and associated chemicals [1:30]; Definitions: microplastics, BPA, PM2.5, phthalates, and more [6:30]; The reasons behind the increase in microplastics in our environment and the surge in interest in them [12:00]; The various ways that humans are exposed to microplastics and nanoplastics [14:00]; Volume of plastic consumed by humans, and how the body eliminates or absorbs microplastics [16:00]; How microplastics accumulate in the body, the variability in tissue accumulation, and the challenges in studying their long-term health effects [21:30]; Limitations of blood tests for microplastics, and the importance of reliable biomarkers for guiding behavior and interventions [26:30]; The speculative health risks of microplastics, the limitations of current research, and the need for more robust studies [29:15]; The challenges of measuring microplastics in human tissues, the need for better methodologies, and the importance of critically evaluating study relevance and claims [39:45]; If it’s unclear whether microplastics actually cause harm, should we still be concerned about exposure? [42:15]; Strategies to minimize microplastic exposure [45:00]; The financial cost and effort involved in various microplastic exposure mitigation strategies [51:00]; The role of airborne microplastics in total exposure and accumulation [1:03:00]; Chemicals associated with plastics, their role as endocrine disruptors, and the challenges in linking exposure to specific health outcomes [1:04:00]; BPAs: role in plastic production, and its potential developmental risks [1:05:45]; BPA's potential health risks: pregnancy, fertility, obesity, and diabetes, and the socioeconomic confounders in the data [1:08:30]; Regulatory limits on BPA exposure, and practical considerations for reducing exposure [1:12:45]; The prevalence of BPA in modern products and how to identify it [1:17:15]; PFAS: chemical structure and purpose in products [1:18:30]; Why PFAS are considered endocrine disruptors [1:19:45]; The main sources of PFAS exposure, and practical steps to reduce exposure [1:21:30]; The potential health risks of PFAS exposure [1:24:00]; Phthalates: role in making plastics flexible and presence in personal care products [1:24:45]; Why phthalates are considered endocrine disruptors [1:25:15]; The main sources of phthalate exposure, and how manufacturing practices are evolving to reduce exposure [1:26:45]; Practical strategies to reduce exposure to phthalates in food, air, water, and personal care products [1:28:30]; Navigating microplastics and associated chemicals: a framework for personalized risk reduction [1:29:30]; and More. Connect With Peter on Twitter , Instagram , Facebook and YouTube…

1
#331 ‒ Optimizing endurance performance: metrics, nutrition, lactate, and more insights from elite performers | Olav Aleksander Bu (Pt. 2) 2:16:12

7 weeks ago2:16:12

2:16:12

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter 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 returns to dive deeper into his groundbreaking work as an endurance coach, exercise scientist, engineer, and physiologist. The discussion explores his data-driven approach to coaching, unpacking key performance metrics like functional threshold power, VO2 max, and lactate threshold, while emphasizing the importance of consistent testing protocols. Olav shares insights on how training methodologies differ across sports, the impact of nutrition on endurance performance, and the evolving strategies for carbohydrate metabolism in fueling athletes for races. Olav concludes with a discussion on the use of artificial intelligence for optimizing training insights and performance. We discuss: Olav’s unique, engineering-driven approach to endurance coaching [2:45]; Definitions and applications of key performance metrics: FTP, power, anaerobic threshold, and lactate threshold [4:45]; Lactate threshold: factors affecting lactate threshold, testing protocols, and how elite athletes' efficiency affects their performance and lactate profiles [14:15] VO2 max: definition, testing, factors affecting its accuracy, and methods for optimizing oxygen utilization in elite athletes [22:15]; Testing VO2 max: common mistakes and key factors to consider—preparation, warm-up, timing, and more [34:00]; VO2 max testing continued: measuring instruments, testing protocols, and advanced insights gained from elite athletes [41:45]; The influence of supplements like beetroot concentrate and adaptogens on VO2 max and performance [49:45]; How respiratory quotient (RQ) reflects metabolic shifts during exercise, the challenges in measuring and interpreting RQ in elite athletes, and the physiological adaptations needed for prolonged endurance events [53:30]; Triathlon training: the challenge of maintaining elite performance across triathlon distances, metabolic efficiency, and swimming challenges [1:03:15]; How reducing drag in swimming could revolutionize performance and the role of biofeedback tools in optimizing efficiency across various endurance sports [1:07:00]; How endurance athletes prioritize effort regulation using RPE, heart rate, and power output, and the role of lactate in cardiac and athletic efficiency [1:20:00]; Lactate’s role as a fuel, buffering methods to combat lactic acidosis, and the variability in athlete response to bicarbonate supplementation [1:25:45]; The physiological mechanisms behind differences in performance between two elite athletes: lactate transport, cardiovascular efficiency, and compensatory systems [1:33:00]; Comparing interventions like acetaminophen to enhance performance in high-heat conditions versus natural adaptations to heat [1:37:15]; Advancements in nutrition science, changes in cyclist body composition, and the impact of fueling strategies on athletic performance and growth [1:39:30]; Optimizing endurance performance with utilization of carbohydrates, and the potential role of ketones [1:48:00]; Insights gained from elite performers in the 2020 and 2024 Olympics [1:58:30]; The use of artificial intelligence to optimizing training insights and performance [2:06:30]; and More. Connect With Peter on Twitter , Instagram , Facebook and YouTube…

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#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D. 1:57:14

8 weeks ago1:57:14

1:57:14

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Trenna Sutcliffe is a developmental behavioral pediatrician and the founder and medical director of the Sutcliffe Clinic in the San Francisco Bay Area, where she partners with families to provide care for children facing behavioral challenges, developmental differences, and school struggles. In this episode, Trenna shares her journey into developmental and behavioral pediatrics, including her pioneering work at Stanford and her expertise in autism, ADHD, and anxiety—the "three As." She explores the diagnostic processes, the overlap and comorbidities of these conditions, and the importance of personalized treatment plans that address both medical and environmental factors. Trenna offers valuable insights into the changing prevalence of autism, the impact of evolving diagnostic criteria, and the range of therapies and medications available to support children and their families. She also discusses the challenges in accessing care and the critical need for a holistic approach that bridges healthcare and education. We discuss: Trenna’s passion for developmental-behavioral pediatrics (DBP), and the process of diagnosing anxiety, ADHD, and autism [3:15]; Understanding anxiety and ADHD: assessing impairment and self-esteem and identifying anxiety and emotional well-being in young patients [9:45]; The evolving diagnosis of autism: understanding the spectrum and individual needs [16:30]; The dramatic rise in autism spectrum disorder (ASD): genetics, environment, expanded diagnostic criteria, and more [25:45]; Exploring epigenetics and the potential multigenerational impact of environment exposures on susceptibility to certain disorders [37:15]; The evolution of autism classifications, and the particular challenges for children with level 1 (mild) autism due to a lack of support [41:15]; The broadening of the autism spectrum: benefits and risks of expanded diagnostic criteria and the need for future frameworks to focus on better outcomes [48:00]; The overlap between ASD, ADHD, and anxiety [57:15]; Understanding oppositional defiant disorder, and the importance of understanding the “why” behind a behavior when creating treatment plans [1:00:45]; Defining developmental-behavioral pediatrics (DBP), and Trenna’s professional journey [1:07:00]; Updated methods of ABA (applied behavioral analysis) therapy: evolution, controversies, challenges of scaling autism care, and the need for tailored interventions [1:13:45]; Advice for parents trying to find and evaluate care for children with autism, ADHD, or anxiety [1:22:45]; Tailored treatments for ADHD: balancing stimulant medications with behavioral training [1:28:30]; The interplay between medication, behavioral therapy, and neuroplasticity in managing ADHD, and the potential to grow out of the need for medication [1:39:45]; Using medication to treat anxiety and other symptoms in kids with autism without ADHD [1:44:45]; FAQs about medicating children with ADHD: benefits, side effects, dosage, and more [1:46:30]; The “superpowers” associated with level 1 autism [1:48:45]; The next steps to increase support for children with ASD, anxiety, and ADHD [1:50:45]; and More. Connect With Peter on Twitter , Instagram , Facebook and YouTube…

1
Building & Changing Habits | James Clear (#183 rebroadcast) 2:19:56

9 weeks ago2:19:56

2:19:56

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter 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. Connect With Peter on Twitter , Instagram , Facebook and YouTube…

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#329 ‒ Special AMA: Peter on exercise, important labs, building good habits, promising longevity research, and more 27:14

11 weeks ago27:14

27:14

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this special episode of The Drive, Peter tackles a wide range of listener questions submitted over the past year. The discussion spans essential topics such as exercise—covering grip strength, traveling workouts, and why Peter doesn’t consider exercise an ideal weight-loss strategy—and the top biomarkers everyone should track. He also explores promising new longevity research, his evolving views on longevity, and frameworks like “objective, strategy, tactics” for personalized decision-making. The episode wraps up with insights on building good habits and a glimpse into Peter’s recent reading list. 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 Special AMA show notes page . If you are not a subscriber, you can learn more about the subscriber benefits here . We discuss: Overview of episode topics (and Peter’s car stereo saga) [1:45]; The importance of grip strength and the best methods for training it effectively [3:45]; Exercise while traveling: strategies for staying active and maintaining an exercise routine [14:45]; Why women should prioritize strength training [18:00]; The limited role of exercise in weight loss and its greater importance in improving health, body composition, and insulin sensitivity [19:45]; The “top five most important biomarkers” for assessing health [22:45]; Promising developments in longevity research [28:15]; The development of Klotho as a neuroprotective drug: challenges, timelines of trials, and more [34:00]; Peter’s updated view on the potential of epigenome manipulation to restore aged cells to their youthful state [39:45]; How reversing age-related epigenetic changes in immune cells could revolutionize our approach to aging and disease [43:30]; The “objective, strategy, tactics” framework, and the importance prioritizing impactful lifestyle habits over less significant health trends [49:30]; Strategies for building and maintaining good habits [56:45]; How to think about drugs and supplements as part of a longevity toolkit [1:02:00]; Peter’s recent reading list [1:05:15]; and More. Connect With Peter on Twitter , Instagram , Facebook and YouTube…

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#328 - AMA #66: Optimizing nutrition for health and longevity: myth of a “best” diet, complexities of nutrition science, and practical steps for building a sustainable diet 16:38

12 weeks ago16:38

16:38

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this "Ask Me Anything" (AMA) episode, Peter dives deep into one of the most frequently discussed and often misunderstood topics: nutrition. From weight loss and maintenance to the intricate relationship between nutrition and exercise and body composition, Peter addresses the complexities of nutrition research and explores the perennial question of whether there is a "best diet." He provides practical insights on how to choose the right diet for your unique needs, discusses the role of protein and processed foods, and outlines the key questions to help you optimize your approach to eating. 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 #66 show notes page . If you are not a subscriber, you can learn more about the subscriber benefits here . We discuss: The key nutrition-related topics to be discussed [1:30]; Why Peter is not fond of discussing nutrition: limitations of nutrition research, the pitfalls of extreme certainty in dietary discussions, and the body's adaptability to varied diets [3:30]; Key health metrics to monitor to evaluate the effects of nutrition [9:30]; The relationship between nutrition and exercise as they relate to weight loss, maintenance, and gain [12:30]; How increased muscle mass from resistance training impacts calorie burn, body composition, glucose metabolism, and overall health benefits [19:45]; Comparing the impact of fitness and nutrition on lifespan and healthspan: data showing fitness to be a more significant predictor of mortality than nutrition [23:30]; The myth of a “best diet,” factors that determine the effectiveness of a diet, and data suggesting benefits of the Mediterranean diet [39:00]; How long to trial a new diet, the importance of measurable goals, and the appropriate timescales for observing meaningful changes [48:30]; The inherent challenges in nutrition research: variability in dietary exposures, limitations in study design, the body’s adaptive nature which dampen the effects, and more [51:15]; Nutritional approaches for chronic diseases like cardiovascular disease and type 2 diabetes [58:45]; Emerging studies on dietary interventions for non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) [1:02:45]; Practical considerations for individuals to identify the best diet for them: protein intake, energy balance, macronutrient adjustments, and micronutrient levels [1:06:00]; Understanding processed vs. ultra-processed foods [1:09:15]; The effects of ultra-processed foods on health [1:12:30]; Questions that someone should ask themselves if they’re looking to fine-tune their diet [1:18:15]; and More. Connect With Peter on Twitter , Instagram , Facebook and YouTube…

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#327 - Choices, costs, and challenges in US healthcare: insurance intricacies, drug pricing, economic impacts, and potential reforms | Saum Sutaria, M.D. 2:32:46

13 weeks ago2:32:46

2:32:46

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Dr. Saum Sutaria is the Chairman and CEO of Tenet Healthcare and a former leader in McKinsey & Company’s Healthcare and Private Equity Practices, where he spent almost two decades shaping the field. In this episode, Saum unpacks the complexities of the U.S. healthcare system, providing a detailed overview of its structure, financial flows, and historical evolution. They delve into topics such as private insurance, Medicare, Medicaid, employer-sponsored coverage, drug pricing, PBMs and the administrative burdens impacting the system. Saum’s insights help connect healthcare spending to broader economic issues while exploring potential reforms and the role of technology in improving efficiency. Saum highlights how choice and innovation distinguish the U.S. healthcare system, explores the reasons behind exorbitant drug prices, and examines the potential solutions, challenges, and trade-offs involved in lowering costs while striving to improve access, quality, and affordability. The opinions expressed by Saum in this episode are his own and do not represent the views of his employer. We discuss: The US healthcare system: financial scale, integration with economy, and unique challenges [5:00]; Overview of how the US healthcare system currently works and how we got here [9:45]; The huge growth and price impact due to the transition from out-of-pocket payments in the 1950s to the modern, third-party payer model [18:30]; The unique structure and challenges of the US healthcare system compared to other developed nations [22:00]; Overview of Medicare and Medicaid: who they cover, purpose, and impact on healthcare spending [27:45]; Why the US kept a employer-sponsored insurance system rather than pursue universal healthcare [32:00]; The evolution of healthcare insurance: from catastrophic coverage to chronic disease management [36:00]; The challenge of managing healthcare costs while expanding access and meeting increased demand for chronic illness care [44:15]; Balancing cost, choice, and access: how the US healthcare system compares to Canada [48:45]; The role of the US in pharmaceutical innovation, it’s impact on drug pricing, and the potential effects of price controls on innovation and healthcare costs [56:15]; How misaligned incentives have driven up drug prices in the US [1:05:00]; The cost of innovation and choice, and the sustainability of the current healthcare cost expenditures in the US in the face of a shrinking workforce and aging population [1:11:30]; Health outcomes: why life expectancy is lower in the US despite excelling at extending lifespan beyond 70 [1:18:45]; Potential solutions and challenges to controlling drugs costs in the US while balancing choice and access and preserving innovation [1:26:15]; Balancing GLP-1 drug innovation with affordability and healthcare spending sustainability [1:40:00]; Reducing healthcare spending: complexities, trade offs, and implications of making needed cuts to healthcare expenditures [1:46:45]; The role of government regulation, opportunities for cost savings, and more [1:56:15]; Hospital billing: costs, charges, complexities, and paths to simplification [2:01:15]; How prioritizing access and choice increased expenditures: reviewing the impact of healthcare exchanges and the Affordable Care Act [2:08:00]; Feasibility of a universal Medicare program, and what a real path to sustainable healthcare looks like [2:15:45]; The challenge of long-term care and the potential of innovation, like device-based therapies and AI, to improve health [2:23:15]; and More. Connect With Peter on Twitter , Instagram , Facebook and YouTube…

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Optimizing life for maximum fulfillment | Bill Perkins (#237 rebroadcast) 1:43:50

14 weeks ago1:43:50

1:43:50

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Bill Perkins is one of the world’s most successful hedge fund managers and entrepreneurs, and the author of the bestseller, Die With Zero. In this episode, Bill unpacks the Die With Zero philosophy which challenges conventional thinking related to the balance between health, wealth, and time—the three variables important for fulfillment. Bill makes the case that we should strive for maximum net fulfillment rather than net worth (or even health). He argues that we need to optimize our life to have memorable experiences before it’s too late and that most people are over-saving and under-living. Bill also explains how one can apply the principles in Die With Zero to break out of “autopilot” and optimize their life to achieve maximum net fulfillment. We discuss: Bill’s upbringing, background, and first job on Wall Street [2:45]; A missed experience and feeling of regret that shaped Bill’s thinking [13:45]; Thinking in terms of time, and the relationship between money, time, and health [16:30]; Solving for net fulfillment and allocating your time based on the seasons of life [26:45]; How Bill thinks about risk, opportunity costs, and the difference between fear and risk tolerance [35:00]; Optimizing for fulfillment, finding purpose outside of work, and more [41:15]; Thinking about the order of experiences you want to have based on seasons of life [49:30]; Bill’s unique perspective on philanthropy and a more impactful way to give money away [54:15]; Applying the principles in ‘Die With Zero’ to maximize fulfillment [1:03:30]; How to break out of living life on autopilot [1:13:45]; When should your net worth peak? [1:17:30]; Taking calculated risks [1:21:00]; Bill shares a lesson from his incredible birthday [1:24:45]; How Bill’s philosophy has evolved since writing Die With Zero [1:33:30]; and More. Connect With Peter on Twitter , Instagram , Facebook and YouTube…

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#326 - AMA #65: Red light therapy: promising applications, mixed evidence, and impact on health and aging 15:04

15 weeks ago15:04

15:04

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter dives into the world of red light therapy in response to frequent questions from listeners. Peter provides a comprehensive exploration, starting with the basics of red light therapy and why it’s getting so much attention. The conversation examines the latest data on various applications, including aging, skin health, acne, wound healing, hair loss, eye health, exercise performance, metabolic health, weight loss, inflammation, injury recovery, and menstrual cramps. Peter analyzes the scientific literature on each use case and concludes with a summary table that provides an easy-to-follow breakdown of the potential benefits of red light therapy across these areas. 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 #65 show notes page . If you are not a subscriber, you can learn more about the subscriber benefits here . We discuss: Overview of topics and the motivation behind exploring red light therapy [1:45]; The basic science of red light therapy [3:15]; The unique penetration properties of red light [6:00]; What happens when tissue is exposed to red light [9:30]; Exploring red light therapy’s potential to combat aging [11:00]; Red light therapy for treating acne [13:00]; Red light therapy for aiding in wound healing [18:45]; Red light therapy for hair loss: promising benefits and practical advice [24:15]; Analyzing the evidence of a positive or negative effect of red light therapy on the eyes [28:00]; Red light therapy’s impact on performance and recovery [30:30]; Red light therapy’s impact on metabolic health: analyzing the limited evidence for improved glucose metabolism [32:45]; Red light therapy for weight loss and targeted fat reduction [36:45]; Red light therapy for inflammation, chronic pain, and injury rehabilitation [41:00]; Red light therapy as a treatment for menstrual cramps [43:45]; Summary: promising applications of red light therapy, unsupported claims, and costs to consider [46:45]; and More. Connect With Peter on Twitter , Instagram , Facebook and YouTube…

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#325 ‒ Peter’s key takeaways on bone health, calorie restriction and energy balance, dopamine and addiction, gene editing, and testosterone therapy safety with a prostate cancer diagnosis |… 25:02

16 weeks ago25:02