Dive into the complete episode list for The Peter Attia Drive. Each episode is cataloged with detailed descriptions, making it easy to find and explore specific topics. Keep track of all episodes from your favorite podcast and never miss a moment of insightful content.
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Pub. Date
Title
Duration
16 Sep 2019
#71 - Katherine Eban: Widespread fraud in the generic drug industry
02:41:33
In this episode, Katherine Eban, investigative journalist and author of Bottle of Lies, illuminates the prevalence of fraud in generic drug manufacturing which brings into question the idea that generics are identical to brand-name drug as we are lead to believe. Katherine walks us through how this widespread corruption came to be, including the shocking story of one particularly egregious (and unfortunately not uncommon) example of an Indian drug company, Ranbaxy, whose business model was completely dependent on falsifying data in their drug applications to the FDA. We then discuss the subsequent investigation into Indian and Chinese drug manufacturing plants which revealed that nearly 80% of them are tainted with fraud. We conclude this discussion on a positive note with i) how individuals can investigate their own drugs to protect themselves ii) an innovative pharmacy attempting to disrupt the market and iii) some ideas on how to reform to the regulations around generic drugs, the FDA, and more.
We discuss:
How Peter found Katherine’s book, and what convinced her to investigate the generic drug industry [5:45];
Branded vs. generic drugs: Why they aren’t the same thing [11:15];
The Food and Drug Administration: Why it was originally created and what it does today [20:45];
How the generic drug industry really got its start in the U.S., and the flaw of the Hatch-Waxman Act [28:20];
PEPFAR: How a well-intentioned plan to help Africa with the AIDS epidemic laid the groundwork for corruption [36:30];
The story of Ranbaxy: An Indian drug company whose business model was fraud and deceit [40:45];
How the FDA approves drugs, the impact of “first to file”, and Peter’s tangent on moral corruption [47:30];
A booming generic drug market and the FDA struggling to keep up [57:15];
Dinesh’s internal investigation finds widespread fraud and falsified data inside Ranbaxy [1:00:15];
Presenting the famous SAR document to Ranbaxy’s board of directors which spells out the company-wide fraud [1:09:15];
Dinesh blows the whistle on Ranbaxy which leads to a raid on their US plant [1:19:45];
Formal investigation of Ranbaxy is launched, but the FDA keeps approving Ranbaxy drug applications [1:33:30];
What role does the culture in India play in the high prevalence of fraud in the drug industry? [1:41:00];
The extreme prevalence of data fraud/manipulation in foreign generic drug factories [1:52:30];
Concluding the Ranbaxy story [2:06:15];
How concerned should you be when buying a generic drug from your local pharmacy? [2:11:15];
How to investigate your own drugs for quality to ensure you are getting what you need [2:18:30];
An innovative pharmacy that tests all its drugs for quality [2:24:45];
Reforming the FDA and generic drug industry: Why we need reform and ideas on how to do it [2:27:45];
The importance of taking individual ownership and not waiting for Congress to bail us out [2:34:00];
#23 - Tom Dayspring, M.D., FACP, FNLA – Part IV of V: Statins, ezetimibe, PCSK9 inhibitors, niacin, cholesterol and the brain
02:00:05
In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. In Part IV, Peter and Tom review the history and current use of drugs to prevent cardiovascular disease. They also discuss why some drugs appear to be more effective than others, an in-depth conversation about niacin, cholesterol and brain health, and the futility of using CKs (creatinine kinase) and liver function tests to identify adverse effects in statins, to name a few topics in this episode.
#38 - Francisco Gonzalez-Lima, Ph.D.: Advancing Alzheimer’s disease treatment and prevention – is AD actually a vascular and metabolic disease?
02:31:55
In this episode, Francisco Gonzalez-Lima, a Professor of Neuroscience and Pharmacology & Toxicology, explains the vascular hypothesis of Alzheimer’s disease which says the central problem is a progressive neuronal energy crisis of impaired blood flow to the brain and impaired mitochondrial respiration. He walks us through the ways we can intervene in this process and also shares details of the exciting future of Alzheimer’s treatment and prevention.
#170 - AMA #25: Navigating the complexities and nuances of cancer screening
00:12:28
In this “Ask Me Anything” (AMA) episode, Peter and Bob dive deep into cancer screening, including why it’s important, what you need to know about a test, and Peter’s approach with patients. They specifically discuss various screening methods, explain important terms like sensitivity and specificity, and how layering and stacking different tests in tandem can improve predictive values. They conclude with a discussion on one of the more exciting screening tools, diffusion-weighted MRI, and how it’s changing the cancer screening landscape.
If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #25 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
We discuss:
The importance of cancer screening [1:15];
Cancer screening terms: sensitivity, specificity, false positives, and false negatives [8:25];
Cancer screening terms: positive and negative predictive value [17:00];
Improving predictive value by layering tests, and the predictive values of mammograms [25:45];
How smoking impacts the predictive value of cancer screening [30:45];
Liquid biopsies for ruling out cancer and the blind spots of common cancer screening tests [33:00];
The difference between cancer originating from inside versus outside the body [41:15];
How diffusion-weighted MRI is changing cancer screening [45:15];
Summary of Peter’s approach to cancer screening [53:45]; and
David Allison is an award-winning scientific writer who has been at the forefront of obesity research for the last 20 years. Currently the Dean of the Indiana University School of Public Health, he has also authored many publications on statistical and research methodology and how to improve research rigor and integrity. David’s focus on evidence and data brings forth an interesting discussion of what we know (and don’t know) about the science of obesity. He provides an insightful and unemotional explanation of the potential impact of nutritional epidemiology in public health while also explaining its many pitfalls and limitations. He offers his take on the path forward in addressing the obesity epidemic, and he closes with a lucid explanation for the evident lack of credibility in science and the steps we can take to change that.
We discuss:
David’s background, interest in obesity, and focus on evidence [5:00];
The moment when the obesity crisis was recognized, and the sloppy science that ensued [13:00];
What twins studies tell us about the genetics of obesity [20:30];
How doctors and scientists have historically approached obesity treatment [23:45];
Do surgical procedures for obesity prolong life? [32:00];
The ‘Obesity Paradox’ [36:00];
Interpreting BMI and mortality data and considering confounders [43:15];
How body composition and ethnicity factor into consideration of BMI data [50:30];
Superior tools for measuring obesity at the individual level [57:15];
Using BMI data for actionable steps to combat obesity [1:02:00];
Why maintaining weight loss is more challenging than losing weight [1:06:00];
Differing perspectives on the utility of nutritional epidemiology [1:16:30];
A mouse study illustrating the impossibility of fully controlling for confounds in observational studies [1:22:15];
Limitations of nutritional epidemiology and how it can improve [1:26:30];
Addressing the obesity epidemic—the path forward and obstacles to overcome [1:37:15];
What David believes to be the most promising interventions we could take to address obesity and improve public health [1:47:30];
Reproducibility in science, normative and non-normative errors explained [1:51:30];
Rebuilding trust in science and differentiating between science and advocacy [1:59:00];
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];
The Qualysis a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed.Qualysis short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day.The Qualysare short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed onThe Drive.
Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.
Kelsey Chittick is the author of Second Half: Surviving Loss and Finding Magic in the Missing. In this episode, Kelsey describes her long healing process following the sudden death of her husband, former NFL player Nate Hobgood-Chittick. She describes her life with Nate before and after football, including her premonitions that something was off about Nate and the subsequent finding that he suffered from chronic traumatic encephalopathy (CTE). She speaks openly about how she handled his death with her children, the trauma and grief they faced in the aftermath, and how she’s found ways to be happy in her new life. She shares deep insights into her healing process, including her experience with psychedelics and how the concept of “radical acceptance” has helped her to find joy once again.
We discuss:
Kelsey’s childhood in Florida as an athlete [2:15];
Meeting Nate and early relationship with him [7:45];
Nate’s unbelievable work ethic and desire to play in the NFL [12:30];
Life with a professional football player, playing through pain, and head injuries related to football [17:00];
Nate’s final days of football and early retirement struggles [23:30];
The tough transition from the NFL to a “regular life” and how Nate found a way to serve others [28:45];
Nate’s struggle with his weight and overall health after retirement [34:45];
Kelsey’s anxiety and premonitions of Nate’s impending death, and Nate’s changing demeanor [37:30];
The traumatic experience of learning of Nate’s death during her own spiritual journey to Jamaica [45:30];
Breaking the news to her children of their father’s death [51:00];
The darkest days following Nate’s passing and how her children were handling grief [55:30];
A new relationship with death, finding happiness, and the duality of feelings [1:02:45];
Nate’s autopsy results showing evidence of CTE [1:07:00];
The grieving process [1:15:00];
Dealing with grief with kids and how children grieve differently [1:19:15];
Healing through her first psychedelic experience [1:23:00];
The therapeutic potential of psychedelics, meditation, and more [1:33:45];
The concept of “radical acceptance” and the peace that comes with it [1:42:30];
The up and down experience of writing her book [1:47:45];
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.
#47 – Matthew Walker, Ph.D., on sleep – Part I of III: Dangers of poor sleep, Alzheimer's risk, mental health, memory consolidation, and more.
01:43:11
In part 1 of this 3 part series, Matthew Walker, professor of neuroscience at UC Berkeley and expert on sleep, describes the different stages and cycles of sleep, including what he calls the 4 pillars of sleep, and how they contribute to memory consolidation and numerous important pathways to mental health. We also get into the dangers of chronic sleep deprivation, such as the development of dementia, and the more acute dangers of sleep deprivation like fatal car crashes which are most often caused by drowsy driving. We also discuss the different and important roles of REM vs. non-REM sleep, and the impact that bad sleep habits can have specifically on those sleep stages.
We discuss:
Matthew’s background and interest in sleep [6:03];
Sleep and Alzheimer’s disease, and the 4 pillars of sleep [12:18];
Stages of sleep, sleep cycles, and brain waves [41:18];
Memory and sleep, and the risk of insufficient REM sleep [55:48];
Evolutionary reasons to sleep [1:02:03];
The early riser vs. the night owl, and tips for overcoming jet lag [1:10:18];
Is there one type or stage of sleep that is most important? [1:17:33];
The dangers of drowsy driving [1:28:48];
The timeliness of Matthew’s book, and how the conversation of sleep has changed over the past several years [1:35:18]; and
#32 - Siddhartha Mukherjee, M.D., Ph.D.: new frontiers in cancer therapy, medicine, and the writing process
01:05:11
In this episode, Siddhartha Mukherjee, oncologist, researcher, and author of the Pulitzer Prize-winning book “The Emperor of All Maladies: A Biography of Cancer,” discusses his writing process, his thoughts about medicine, cancer, immunotherapy, and his recent collaboration on a study combining a ketogenic diet with a drug in mice that provided remarkable and encouraging results.
The Qualysis a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed.Qualysis short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day.The Qualysare short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed onThe Drive.
Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.
The Qualysis a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed.Qualysis short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day.The Qualysare short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed onThe Drive.
Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.
#160 - Paul Offit, M.D.: The latest on COVID-19 vaccines and their safety, herd immunity, and viral variants
01:25:39
Paul Offit is a pediatrician specializing in infectious diseases and an expert in virology and vaccine development. He currently serves on the FDA committee evaluating COVID-19 vaccines. In this episode, Paul’s second appearance on The Drive, he provides an update on all the SARS-CoV-2 vaccines currently deployed, explains why the concerns raised around the mRNA vaccines are not legitimate, and offers his view on the prospects and timeframe of reaching herd immunity. He also takes a deep dive into immunology, explaining the short-term and long-term immune response to both natural infection and vaccination and how these two can function together to provide durable immunity. Additionally, they discuss the theories on the origins of this virus, what impact the new COVID-19 variants might have, and the recent pausing of the J&J vaccine. Finally, they discuss how we can be better prepared for an inevitable future outbreak of a novel virus. This episode was originally recorded on April 14, 2021.
We discuss:
Overview and current status of the SARS-CoV-2 vaccine strategies [4:10];
Addressing concerns about mRNA vaccines [9:00];
How the failure to make an effective HIV vaccine aided the development of a COVID-19 vaccine [16:45];
Where SARS-CoV-2 falls on the spectrum of its ability to mutate and what that means for immunity and vaccination [21:30];
How the combination of short-term and long-term immune response to SARS-CoV-2 work together to provide durable immunity [28:00];
Importance of understanding relative vs. absolute risk reduction [38:15];
Implications of pausing the J&J vaccine due to reports of blood clotting in the brain [42:45];
What constitutes herd immunity and the concerns of rising vaccine hesitancy [47:45];
When we might reach herd immunity, future vaccines for children, and long-term outlook for maintaining population immunity [58:45];
Theories about the origins of SARS-CoV-2 [1:07:00];
Preparing for the possibility of a future pandemic and how we can learn from our mistakes [1:10:40]; and
Dr. Matt Kaeberlein is a globally recognized expert on the biology of aging and recurring on The Drive. In this episode, Matt explains his research findings on nutrition as it relates to aging and longevity, including the results from his recent review article in Science. From there, he and Peter dive deep into the literature on calorie restriction (CR), explaining the nuance, benefits for lifespan and healthspan, and potential downsides of CR. He discusses the epigenetic changes that occur with age and potential benefits and downsides of epigenetic reprogramming, often viewed as a panacea for reversing aging. Matt also explains the impact of dietary protein on aging, including the interesting dichotomy around how protein, a critical macronutrient, and rapamycin, a geroprotective molecule, have opposite effects on mTOR. Additionally, he talks about low-protein vs. high-protein diets and their effects on muscle mass and mortality, as well as the impact of IGF-1 signaling and growth hormone on lifespan.
We discuss:
Challenges with understanding the effects of nutrition and studying interventions for aging [3:30];
How Peter’s and Matt’s convictions on nutrition and thoughts optimal health have evolved [8:15];
Calorie restriction for improving lifespan in animal models [16:15];
Utility of epigenetic clocks and possibility of epigenetic reprogramming [22:00];
Mutations and changes to the epigenome with aging [31:45];
Epigenetic reprogramming: potential benefits and downsides and whether it can work in every organ/tissue [35:15];
First potential applications of anti-aging therapies and tips for aging well [43:00];
Impact of calorie restriction on the immune system, muscle mass, and strength [47:00];
Insights from famous calorie restriction studies in rhesus macaques [55:00];
An evolutionary perspective of the human diet [1:03:45];
Antiaging diets: Separating fact from fiction—Matt’s 2021 review in Science [1:12:30];
Mouse models of time-restricted feeding in the context of calorie restriction [1:19:30];
Nutritional interventions that consistently impact lifespan in mice, and concerns around efficacy in humans [1:27:00];
Differing impact of calorie restriction when started later in life [1:31:00];
Lifespan extension with rapamycin in older mice [1:37:15];
Relationship between protein intake and aging, and mouse studies showing protein restriction can extend lifespan [1:43:30];
Impact of protein intake on mTOR, and why inhibition of mTOR doesn’t cause muscle loss [1:50:45];
Low-protein vs. high-protein diets and their effects on muscle mass, mortality, and more [1:55:30];
The impact of IGF-1 signaling and growth hormone on lifespan [2:06:30];
Parting thoughts on the contribution of nutrition to healthspan and lifespan [2:19:45];
#33 - Rudy Leibel, M.D.: Finding the obesity gene and discovering leptin
02:20:29
In this episode, Dr. Rudy Leibel, an expert in Clinical Molecular Genetics and Genomics at Columbia University, discusses his role in the remarkable scientific story of discovering leptin. He also gets into the genetics of obesity, as well as a broader discussion of the causes and effects of obesity, energy expenditure, and metabolism.
We discuss:
Rudy’s background, interest in obesity, and trying to understand the role and impact of adipose tissue [4:15];
Finding the first evidence of leptin by studying obese mice [23:30];
Zucker rats, and the push/pull theories of obesity [34:45];
A breakthrough in obesity research, and closing in on leptin [45:45];
Understanding leptin in humans [1:03:30];
What Prader–Willi syndrome teaches us about body weight regulation [1:09:45];
Leptin and the broad condition of obesity, metabolic consequences of weight reduction, and Peter’s self-experiments [1:18:00];
How is appetite being regulated? [1:29:45];
Are there epigenetic consequences of being obese? [1:37:00];
What makes low-carb diets so effective at obesity reduction? [1:46:15];
What did Rudy believe 10 years ago that he no longer believes to be true? [1:55:15];
Rudy’s dream study of the FTO gene [1:57:15];
What the hell does insulin resistance actually mean? [2:08:30]; and
The Qualysis a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed.Qualysis short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day.The Qualysare short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed onThe Drive.
Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.
#122 - Lori Gottlieb: Understanding pain, therapeutic breakthroughs, and keys to enduring emotional health
01:30:12
Lori Gottlieb is a psychotherapist and the bestselling author of Maybe You Should Talk to Someone. In this episode, Lori extracts important lessons from her experiences as both a therapist and a patient. The stories Lori shares has provided her the material for insights into living a more fulfilling life. In our conversation, Lori also dispels some misconceptions about therapy, explains the process of big therapeutic breakthroughs, and reveals the most important steps for enduring emotional health.
We discuss:
Lori’s unique path to becoming a therapist [3:00];
Dissecting cadavers—a profound experience during med school [12:30];
The sunk cost fallacy—How Lori was able to walk away from med school [17:15];
Being aware of the gift of life, and other lessons from Lori’s terminally ill patient [24:00];
How underlying pain can manifest in obnoxious behavior [32:45];
Counseling versus therapy [36:15];
The story of John—why men hide their feelings, breaking down his shield, and uncovering his pain [38:30];
“Breaking open”—A shocking revelation about John that tests Lori’s resolve as a therapist [46:30];
Rewriting your story, the recovery process, and the most important step for lasting change [49:00];
The process of many big therapeutic breakthroughs [56:00];
The 2 types of suicidal thoughts, and the importance of talking about it [1:01:00];
The most common issues that bring patients to therapy with Lori [1:02:45];
Clinging to the familiar—why change is so hard [1:05:15];
A story of shame, lack of self-compassion, and self-sabotage [1:07:00];
The importance of managing mental health to reduce unnecessary suffering [1:15:45];
Dispelling the misconceptions about therapy [1:23:15]; and
#03 - Ron Krauss, M.D.: a deep dive into heart disease
01:56:04
Whenever I’m stumped on a patient case or in my thinking about lipids, Ron is one of the first people I turn to for insight. Ron is recognized globally for his research into lipidology and has worn many hats in his career, including clinician, lipidologist, nutrition, genetics, and drug research.
In this episode, we explore heart disease at its origins before diving into the highly discussed, largely misunderstood, role of LDL and inflammation in atherosclerosis. Ron also shares his insights on the evidence for and against statins and other lipid-lowering therapies. My hope is that both the curious patient and the physician can get a lot out of this episode by being more informed about dyslipidemia and the interventions used to reduce the risk of atherosclerotic disease. We covered a lot of ground on this critically important topic.
We discuss:
The pathogenesis of atherosclerosis [7:00];
How early atherosclerosis begins [12:40];
Ron’s motivation for getting into lipidology [43:00];
How reading an article series in the NEJM in 1967 had a profound impact on him and his career [43:30];
How PCSK9 inhibitors work and why they may be under-utilized [47:00];
#135 - BJ Miller, M.D.: How understanding death leads to a better life
01:54:43
BJ Miller is a hospice and palliative care specialist on a quest to reframe our relationship with death. In this episode, BJ begins with how his own brush with death radically shifted his perspective and ultimately forged his path towards palliative care and helping patients integrate and understand their life in a meaningful way. BJ recounts several moving stories from his patients, which reveal important lessons about overcoming the fear of death, letting go of regret, and what’s most important in life. He discusses the major design flaws of a “death phobic” healthcare system. Furthermore, he makes the case that seeing death as a part of life allows us to live well, as opposed to living to evade death itself. He concludes with a discussion around physician-assisted death as well as his hopes around the use of psychedelics to reduce suffering in end-of-life care.
We discuss:
BJ’s accident leading to the loss of his limbs and his experience inside a burn unit [3:00];
Coping with his amputations—being tough, the grieving process, and the healing properties of tears [14:30];
Going from art history to medical school: the value of a diverse background in medicine [28:15];
How BJ’s new body liberated him [40:00];
How losing his sister to suicide and his disillusionment with medicine altered his path [47:15];
Discovering his path of palliative care—distinct from hospice—in medicine [55:30];
Our complicated relationship with death, and how acknowledging it can release its grip and improve living [1:02:15];
The different distinctions around the fear of death, and how BJ helps his patients negotiate fears [1:10:00];
The major design flaws of a “death phobic” healthcare system [1:14:15];
Common regrets, the value of time, and other insights from interactions with patients in their final moments of life [1:23:00];
The story of Randy Sloan—a case study of playing life out [1:33:45];
Physician-assisted dying: Legality and considerations [1:39:45];
The use of psychedelics in end-of-life care, and what BJ is most excited about going forward [1:45:45]; and
#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
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];
#163 - Layne Norton, Ph.D.: Building muscle, losing fat, and the importance of resistance training
02:41:10
Layne Norton is a physique coach, a natural professional bodybuilder and powerlifter, and holds a Ph.D. in nutritional sciences. In this episode, Layne explains how he became interested in weightlifting and fitness both professional and academically. He provides insights into preventing and managing injuries while using consistency and determination to boost his professional success in bodybuilding and powerlifting. Peter and Layne also review the science of body composition and what’s really driving muscle growth, including the role of nutrition, supplements, and a number of important and misunderstood hormones important to muscle protein synthesis. Furthermore, Layne stresses the importance of maintaining muscle mass even while losing fat for improving metabolic health and longevity and provides the keys to developing healthy habits.
We discuss:
Layne’s childhood and why he gravitated towards weightlifting and bodybuilding [2:45];
Layne’s academic path, overcoming ADHD, and kicking Adderall [11:45];
Paradoxical observations about expertise, and Layne’s career transition to health and fitness [22:00];
The power of persistence and resilience in the face of setbacks [32:15];
Battling injuries, managing back pain, and setting lifting records [43:00];
Bodybuilding vs. powerlifting: comparing and contrasting the training approaches [57:15];
Cutting weight without losing muscle mass: exercise and dietary protocols, fasting, and a look at the literature [1:06:00];
Muscle protein synthesis and the importance of leucine [1:25:30];
Nitrogen balance and muscle protein synthesis, and the regulatory role of hormones for fat flux and muscle growth [1:37:00];
What’s really driving muscle growth: intrinsic vs. systemic factors, IGF, and hormone signaling [1:46:30];
The role of protein, carbohydrates and insulin on muscle growth and preservation, and the importance of context when interpreting study results [1:55:30];
Clarifying the role of cortisol—a misunderstood hormone [2:07:45];
The problem with studies trying to isolate one nutrient [2:15:00];
The important role of inflammation from exercise [2:19:25];
Keys to preserving muscle, and the value of habits, consistency, and resilience [2:23:30]; and
In this “Ask Me Anything” (AMA) episode, Peter answers a number of questions on optimizing sleep. He describes his pre-bedtime routine, how he utilizes a sauna, and his current regimen of medicines and supplements for improving sleep time and quality. He goes in depth on each of the molecules that have shown promise in boosting sleep, including their mechanisms of action as well as any noteworthy contraindications. Peter also discusses sleep wearables, including both the positives and potential negatives of using such trackers, and much 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 on our website at the AMA #42 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
We discuss:
Peter’s current pre-bedtime routine [3:30];
Sauna: Peter’s routine, sleep benefits, and tradeoffs [10:45];
Importance of keeping an open mind as new information arrives [16:15];
Importance of reducing stimulation leading up to bedtime [19:30];
Medications that can enhance sleep: mechanisms of action, contraindications, risks, and Peter’s regimen [20:30];
Why medications can enhance sleep, but should not replace good sleep habits [34:45];
Sleep supplements: mechanisms of action, contraindications, and Peter’s regimen [37:30];
Temperature during sleep, cooling devices, mattresses, and more [53:00];
A tip to help avoid straining your back in the morning [59:15];
Contrasting polysomnography with wearable sleep trackers [1:00:45];
Sleep tracking wearables: interpreting metrics, and the pros and cons of trackers [1:04:30];
#07 - Deep Dive: Lp(a) — what every doctor, and the 10-20% of the population at risk, needs to know
01:16:09
Pronounced, el-pee-little-a, this lipoprotein is simply described as a low density lipoprotein (LDL) that has an apoprotein “a” attached to it...but Lp(a) goes far beyond its description in terms of its structure, function, and the role that it plays in cardiovascular health and disease. Affecting about 1-in-5 people, and not on the radar of many doctors, this is a deep dive into a very important subject for people to understand.
A quick primer on lipoproteins [7:30];
Intro to Lp(a) [11:00];
Lab tests for Lp(a) and reference ranges [20:00];
The physiologic functions of Lp(a) [31:00];
The problems associated with high Lp(a) [34:15];
Lipid-lowering therapies of Lp(a) [44:45];
Lp(a) modification through lifestyle intervention [1:00:45];
High LDL-P on a ketogenic/low-carb-high-fat diet [1:05:30]; and
#19 - Dave Feldman: stress testing the lipid energy model
03:10:16
In this episode, Dave Feldman, discusses his journey from software engineer to n=1 experimenter, his experience with low-carbohydrate diets, and his hypothesis that cholesterol levels are influenced by energy metabolism.
#40 - Tom Catena, M.D.: The world’s most important doctor – to nearly a million patients – saving countless lives in the war-torn and remote villages of Sudan
02:41:46
In this episode, Tom Catena, a missionary physician who runs Mother of Mercy Hospital in the Nuba Mountains in Sudan, describes some of his extraordinary work as the only doctor in a remote, war-torn region of Africa. In terms of individual lives saved, you could argue that there is no other person on the front lines doing more than Tom. Additionally, we explore the manner in which the Nuba people die, which is in striking contrast the ubiquity of chronic disease and self-harm in the west, despite the extreme poverty and unimaginable suffering experienced by the Nuba people. Lastly, we discuss the lessons to be gleaned from the Nuba people, who despite their suffering, live so harmoniously, happily, and resiliently. To support Tom’s mission please visit www.amhf.us.
We discuss:
Background, medical training, and early days of missionary work in Africa [9:00];
Tom arrives at Mother of Mercy Hospital in the Nuba Mountains of Sudan, civil war breaks out, and his staff evacuates [15:45];
Learning surgery on the job and earning the trust of the community [40:45];
The amazing people of Nuba, and why Nuba feels like home to Tom [51:30];
NY Times article about Tom’s work, and Tom’s new venture on the board of Aurora Prize Foundation bringing awareness and funding to other missionaries doing great work [1:03:30];
Tom’s mind-blowing ability to deal with chaos while seeing hundreds of patients per day [1:15:45];
The most afraid Tom has ever been, and how he copes with the emotional trauma of his daily experiences [1:23:30];
The basic tools, technologies, and medicines that Tom is lacking that could save many lives [1:33:30];
The logistical challenge of helping Tom’s hospital, and what Tom really needs [1:39:15];
Diseases in the adult population [1:42:30];
Living without possessions, finding meaning, and being a missionary [1:59:30];
Sense of purpose, happiness, and suicide: Contrasting the US with Nuba [2:11:00];
Other than donations, is there a way people can help Tom and other similar causes? [2:19:15];
The food in Nuba [2:22:30];
Tom’s annual bout of malaria [2:27:30];
Patients that Tom will never forget [2:29:45];
Resources for people wanting to get involved in helping Tom’s work [2:34:45];
Peter tells a story that defines Tom [2:36:00]; and
#46 - Chris Masterjohn, Ph.D.: Navigating the many pathways to health and disease - NAD and sirtuins, methylation, MTHFR and COMT, choline deficiency and NAFLD, TMAO, creatine, and more
02:51:59
In this episode, Chris Masterjohn, entrepreneur, independent researcher, and doctorate in nutrition, elucidates the latest research on the risk and benefits of NAD supplements, and shares his personal intuition on the topic. We also dive deep into choline deficiency and its role in the rising prevalence of nonalcoholic fatty liver disease. From there, Chris enlightens us on the importance of methylation, a simple yet profoundly important biochemical process affecting our physical and mental health. He also describes the variations of the genes MTHFR and COMT, enzymes which play important roles in methylation and which have profound impacts on our well-being.
We discuss:
Chris’s background, falling in love with biochemistry, and decision to pursue research over medicine [7:45];
Choline: what it is, why it is important, and how a deficiency can cause non-alcoholic fatty liver disease [11:45];
NAFLD: increasing prevalence and potential causes [25:00];
TMAO: Should we be worried about the TMAO content in choline and our foods? [39:15];
Types of fatty acids: How they may predispose us to different types of illnesses [53:30];
Why don’t we see low VLDL in patients with NAFLD? [59:45];
Understanding flux, and how machine learning may affect medicine in the near future [1:03:15];
NAD: How it works, supplements, sirtuins, and the central role of the liver [1:09:30];
Intravenous NAD [1:33:00];
Oral NR: Is it the optimal way to get more NAD? [1:38:30];
What is the possible harm of taking an NAD precursor? [1:47:15];
The MTHFR gene [1:49:45];
The methylation pathway [1:58:15];
The COMT gene [2:04:30];
Creatine: The uses and benefits and its important role in methylation [2:10:15];
Dietary strategies for MTHFR: choline, creatine, folate, and glycine [2:16:45];
How to mitigate the negative effects of NAD supplements [2:23:45];
A case study of a person with high homocysteine [2:28:00];
What is the level of evidence that you need to take action? [2:32:15];
Does Chris supplement with NAD precursors? And can it improve symptoms of rosacea? [2:35:45];
Decision making in the face of inconclusive data, and trying to disentangle the placebo effect [2:39:00];
What does Chris believe to be true that very few people would agree with him about? [2:43:15];
#85 - Iñigo San Millán, Ph.D.: Mitochondria, exercise, and metabolic health
02:53:03
In this episode, Dr. Iñigo San Millán, Assistant Professor at the University of Colorado School of Medicine, explains the crucial role of mitochondrial function in everything from metabolic health to elite exercise performance. Iñigo provides a masterclass into the many different energy system pathways, the various fuel sources (including the misunderstood lactate), the six zones of exercise training, and the parameters he uses to measure metabolic health. Additionally, he highlights the power of zone 2 training in its ability to act as a powerful diagnostic tool, and perhaps more importantly as a treatment for mitochondrial and metabolic dysfunction.
We discuss:
Iñigo’s background in sports and decision to focus on education [7:15];
Explaining the various energy systems and fuels used during exercise [14:45];
Iñigo qualifies energy systems into six training zones [26:00];
Lactate is an important fuel source [33:00];
Zone 2 training—physiologic characteristics, fuel sources, lactate, and the transition into zone 3 [40:30];
Using blood lactate levels (and zone-2 threshold) to assess mitochondrial function [47:00];
Accessing mitochondrial function by looking at one’s ability to utilize fat as fuel (with an RQ test) [55:00];
Athletes vs. metabolically ill patients—mitochondria, fat oxidation, muscle glycogen capacity, “fat droplets”, and more [1:00:00];
Physiologic characteristics of zone 3, zone 4, and the lactate threshold [1:20:00];
Fueling exercise—dietary implications on glycolytic function [1:30:30];
Relationship between exercise and insulin sensitivity (and what we can learn from studying patients with type 1 diabetes) [1:46:30];
Metformin’s impact on mitochondrial function, lactate production, and how this affects the benefits of exercise [2:04:15];
Raising awareness for risk of “double diabetes” [2:15:00];
How to dose zone 2 training, and balancing exercise with nutrition [2:18:00];
Proposed explanation of the Warburg Effect: Role of lactate in carcinogenesis [2:27:00];
Doping in cycling, and the trend towards altitude training [2:39:15] and;
#167 - Gary Taubes: Bad science and challenging the conventional wisdom of obesity
02:36:49
Gary Taubes is an investigative science and health journalist and a best-selling author. In this podcast, Gary explains how he developed a healthy skepticism for science as he was transitioning frombeinga physics major tobeginning asa science journalist. He talks about how he was particularly drawn to sussing out “pathologic science,” telling the stories behind his books on the discovery of the W and Z bosons and cold fusion,emphasizing the need for researchers to perform a thorough background analysis. Gary then describes how his work came to focus on public health, nutrition, and obesity. He provides a great historic overview of obesity research and provides his explanation for why the conventional wisdom today is incorrect. We discuss:
Gary’s background in science and journalism, and developing a healthy skepticism for science [2:20];
Gary’s boxing experience, and the challenge of appreciating behavioral risk [8:40];
How Gary developed his writing skills, and what the best science writers do well [16:45];
Example of how science can go wrong, and the story behind Gary’s first book, Nobel Dreams [25:15];
Theoretical vs. experimental physicists: The important differentiation and the relationship between the two [36:00];
Pathological science: research tainted by unconscious bias or subjective effects [40:30];
Reflecting on the aftermath of writing Nobel Dreams and the legacy of Carlo Rubbia [49:45];
Scientific fraud: The story of the cold fusion experiments at Georgia Tech and the subject of Gary’s book, Bad Science [53:45];
Problems with epidemiology, history of the scientific method, and the conflict of public health science [1:09:00];
Gary’s first foray into the bad science of nutrition [1:26:45];
Research implicating insulin’s role in obesity, and the story behind what led to Gary’s book, Good Calories, Bad Calories [1:36:15]
The history of obesity research, dietary fat, and fat metabolism [1:46:00]
The evolving understanding of the role of fat metabolism in obesity and weight gain [1:55:15]
Mutant mice experiments giving way to competing theories about obesity [2:04:00]
How Gary thinks about the findings that do not support his alternative hypothesis about obesity [2:08:00]
Challenges with addressing the obesity and diabetes epidemics, palatability and convenience of food, and other hypotheses [2:14:45];
Challenging the energy balance hypothesis, and the difficulty of doing good nutrition studies [2:25:00]; and
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22 Feb 2021
#150 - Senator Bill Frist, M.D.: A modern Renaissance man's journey through science, politics, and business
02:23:38
Bill Frist is a nationally acclaimed heart and lung transplant surgeon, former U.S. Senate Majority Leader, and is actively engaged in health policy and education reform. In this episode, Bill takes us through his long and varied career in medicine, politics, and business, which includes establishing the organ transplantation program at Vanderbilt as well as rising from the lowest-ranked member of the U.S. Senate to the Majority Leader in two terms. We discuss some of the most significant moments of his time in the Senate, such as advocating for AIDS prevention programs' funding and addressing complicated issues like stem cell research and the end-of-life issues raised by the Terri Schiavo case. We also hear his first-person account of what happened behind the scenes on September 11, 2001, his frustration with our lack of preparation for the pandemic, and his thoughts about the current state of U.S. politics. Finally, we talk about his current endeavors in health policy and education reform.
We discuss:
Bill’s decision to pursue medicine and do organ transplants (3:40);
The miraculous nature of organ transplants: History, Bill’s work, and the most exciting things to come (12:00);
Frist’s experience building up the heart transplant program at Vanderbilt (21:45);
The famous rivalry between surgeons Denton Cooley and Michael DeBakey (29:15);
How the medical field can attract bright young people to pursue medicine (33:00);
Bill’s decision to leave medicine and run for the US senate (38:00);
The value in having scientists and physicians in Congress (47:30);
A discussion on whether or not senators should have term limits (55:30);
The highly polarized nature of politics, and how we can fix it with empathy (1:00:30);
Bill’s time in the Senate and quick rise to Senate Majority Leader (1:05:30);
The lifesaving impact of the President's Emergency Plan for AIDS Relief (PEPFAR) under George W. Bush (1:15:15);
How Bill reversed course on his view of the value and morality of stem cell research (1:19:45);
Complex end-of-life decisions, and Bill’s role in the infamous Terri Schiavo case—a story that captures the conflict among law, morality, and improving technology (1:30:00);
Remembering the events of September 11th from Bill’s perspective in the Senate (1:49:45);
The coronavirus pandemic: Bill’s accurate 2005 prediction, and a discussion about future preparedness (1:56:45);
The divided state of US politics, and how we can come together (2:06:45);
How experience in medicine and politics is shaping Bill’s current endeavors in business, reforming education, palliative care, and more (2:12:45); and
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
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
In this “Ask Me Anything” (AMA) episode, Peter answers questions related to the leading cause of death in both men and women—atherosclerotic cardiovascular disease (ASCVD). He highlights the most important risk factors for ASCVD, such as apoB, LDL, hyperinsulinemia, and Lp(a), and explains the mechanism by which they confer risk and how these factors are interrelated. Peter also dives deep into the data around apoB to try to answer the question of how much residual risk is conferred for ASCVD through metabolic dysfunction once you correct for apoB. He also looks at the data around lifetime risk reduction of ASCVD in the context of low apoB.
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 #42 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
We discuss:
A racecar analogy for understanding atherosclerotic cardiovascular disease [2:00];
Defining and differentiating apoB and LDL-C [10:00];
The interrelated nature of insulin levels, apoB, triglycerides, and ASCVD parameters [13:00];
Another way that hyperinsulinemia plays a role in endothelial dysfunction [18:00];
Why Peter uses the oral glucose tolerance test (OGTT) with all patients [20:15];
Is there any evidence that hyperinsulinemia is an independent contributor to ASCVD? [23:00];
Thinking through risk in the context of high-fat diets resulting in improved metabolic metrics but with an elevation of apoB/LDL-C [27:30];
Thinking through risk in the context of low apoB but higher than normal triglyceride levels [32:15];
The importance of lowering apoB for reducing ASCVD risk [38:15];
Data on men and women with familial hypercholesterolemia that demonstrates the direct impact of high apoB and LDL-C on ASCVD risk [47:45];
Importance of starting prevention early, calcium scores, and explaining causality [52:30];
Defining Lp(a), its impact on ASCVD risk, and what you should know if you have high Lp(a) [56:30];
Lp(a) and ethnic differences in risk [1:00:30];
Why someone with elevated Lp(a) should consider being more aggressive with apoB lowering strategies [1:05:00];
Addressing the common feeling of hesitancy to taking a pharmacologic approach to lower ASCVD risk [1:07:15];
Peter’s take on the 2022 Formula 1 season and thoughts on 2023 [1:15:15]; and
#126 – Matthew Walker, Ph.D.: Sleep and immune function, chronotypes, hygiene tips, and addressing questions about his book
01:41:53
In this episode, sleep expert Matthew Walker returns by popular demand to dive deeper into many sleep-related topics, starting with what we’ve learned about sleep through the lens of the COVID-19 pandemic and how sleep impacts the immune system. He then covers topics such as how dreaming affects emotional health, the different sleep chronotypes, the best sleep hygiene tips, and the pros and cons of napping. Matthew finishes by addressing several of the errors that readers have pointed out in his book, Why We Sleep.
We discuss:
Three ways the coronavirus pandemic impacts sleep [3:30];
The importance of dreaming for emotional health, and how the coronavirus pandemic increases dreaming [11:45];
The impact of alcohol consumption on sleep quality and stress levels [20:00];
Sleep’s impact on the immune system and implications for a future COVID-19 vaccine [27:45];
What determines how much deep sleep and REM sleep you need? [36:30];
Pros and cons of napping, and insights from the sleep habits of hunter-gatherer tribes [42:15];
Sleep hygiene, wind-down routine, and tips for better sleep [56:45];
Understanding sleep chronotypes and how knowing yours can help you [1:06:00];
Night terrors in kids—what they are and why they happen [1:16:30];
Addressing errors found in Matt’s book, Why We Sleep [1:20:45]; and
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];
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
#322 - Bone health for life: building strong bones, preventing age-related loss, and reversing osteoporosis with evidence-based exercise | Belinda Beck, Ph.D.
Belinda Beck, founder of The Bone Clinic and a leading authority on exercise physiology and bone health, delves into the science of osteoporosis, bone density, and the lifelong importance of maintaining skeletal health. In this episode, she explains how the foundation for strong bones is established during childhood, offering valuable advice for parents on optimizing bone health for their kids. She also explores how bone remodeling occurs throughout life, driven by activity, nutrition, and hormones. Belinda highlights the power of resistance training in improving bone strength, even for those at risk of bone loss, and emphasizes the role of essential vitamins and minerals in maintaining bone health. She shares practical strategies, backed by research, for preventing fractures and combating osteoporosis.
We discuss:
Belinda’s journey into bone health research and training [2:45];
The physiology of bone and how bones adapt to mechanical loading [8:15];
Bone development from birth to adulthood, why early life is a crucial period, the functions of osteoblasts and osteoclasts, and gender differences in BMD [14:00];
How parents can optimize their children’s bone health through diet (calcium and vitamin D), sunlight exposure, and physical activity [27:30];
The best sports and activities for promoting bone health, weight training for kids, and advice for parents [36:30];
The impact of corticosteroid use on bone health in children and strategies to minimize negative effects [48:30];
Advice for people in middle age to preserve bone density: physical activity and bone-loading exercises [52:00];
Bone loss during the menopause transition for women: hormone replacement therapy and other strategies to mitigate BMD losses [59:30];
Interpreting the bone mineral density results from a DEXA scan: T-score, Z-score, and more [1:03:00];
The LIFTMOR study: testing the effects of heavy weightlifting on bone health in postmenopausal women with low bone density [1:10:15];
Profound benefits of weight training outside of BMD improvements: exploring the broader impacts on patients in the LIFTMOR study [1:19:30];
Guidance for people wanting to use exercise designed to improve their bone health [1:29:30]; and
The Qualysis a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed.Qualysis short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day.The Qualysare short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed onThe Drive.
Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.
The Ayrton Senna Episode (re-release): Celebrating the greatest driver in Formula 1 history and the cautionary tales of driven individuals
01:03:13
To celebrate the life of the legendary Formula 1 driver Ayrton Senna, 25 years to the day of his tragic death, we are re-releasing this bonus episode. In this episode, Peter and med school colleague (and brilliant psychiatrist) Paul Conti reminisce on their favorite moments in Formula 1 history, their deep admiration for the late Ayrton Senna, and the remarkable careers of their favorite drivers. Paul also helps to illuminate the psychological components that made the luminary drivers great, and the cautionary lessons we can take from their incredible lives.
We discuss:
Who is Ayrton Senna? [3:47];
How Senna’s death changed the sport [9:52];
The 80s & 90s: a remarkable era of Formula 1 [12:57];
Hypothesizing what caused Senna’s fatal crash [17:47];
Comparing Stewart and Senna, their incredible bravery, and what lessons we can learn from them [23:32];
Best documentaries on racing, and some of Senna’s best moments [31:02];
Gilles Villeneuve, Stefan Bellof, and some of the other greats [39:17];
Why Senna is widely acknowledged as the best of all time [46:17];
Great rivalries and personalities [49:32];
Rendezvous, a high-speed drive through Paris [56:52]; and
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
#133 - Vinay Prasad, M.D., M.P.H: Hallmarks of successful cancer policy
02:12:04
Vinay Prasad is a practicing hematologist-oncologist who doubles as a “meta-researcher,” studying the quality of medical evidence, health policy, and clinical trials. In this episode, Vinay discusses the differences in clinical treatment from the existing medical evidence, often leading to useless, or even harmful, outcomes for patients. With a focus in oncology, he takes a deep dive into the field’s structural problems, which include the disconnect between progress and funding, drug costs, and financial conflicts of interest. He concludes with his “six hallmarks of successful cancer policy” as a potential roadmap to sustained progress against cancer and a way to avoid repeating the policy and practice mistakes of the past.
We discuss:
Vinay’s background and unique perspective [3:15];
Medical reversal—the disconnect between research findings and clinical applications in medicine [10:15];
The uniquely challenging field of oncology [22:45];
The importance of bedside manner with cancer patients [30:00];
Structural problems in oncology—Problem #1: Huge costs for small improvements [37:00];
Structural problems in oncology—Problem #2: Medical reversal—when medical practices are adopted based on low levels of evidence [40:15];
Structural problems in oncology—Problem #3: Slow progress in cancer research (despite all the hype and propaganda) [45:00];
Structural problems in oncology—Problem #4: The burden of payment is not matched with those making treatment decisions [54:45];
“No-brainer” moves in oncology [1:06:45];
“Fool’s gold” treatments in oncology [1:09:30];
The six hallmarks of successful cancer policy [1:16:00];
Cancer policy hallmark #1: Independence [1:18:00];
Cancer policy hallmark #2: Evidence [1:28:15];
Cancer policy hallmark #3: Relevance [1:31:30];
Cancer policy hallmark #4: Affordability [1:32:00];
Cancer policy hallmark #5: Possibility [1:47:00];
Cancer policy hallmark #6: Agenda [1:52:00];
Tumor genome sequencing and liquid biopsies [1:54:30];
Vinay’s clinical philosophy, being skeptical without being too contrarian, and practicing medicine without perfect information [2:03:30]; and
In this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of bone health and explains why this is an important topic for everyone, from children to the elderly. He begins with an overview of bone mineral density, how it's measured, how it changes over the course of life, and the variability between sexes largely due to changes in estrogen levels. From there he provides insights into ways that one can improve bone health, from exercise to nutrition supplements to drugs. Additionally, Peter discusses what happens when one may be forced to be sedentary (e.g., bedrest) and how you can work to minimize the damage during these periods.
If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #37 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
We discuss:
Overview of bone health topics to be discussed [1:45];
Bones 101: bone function, structure, and more [5:15];
Bone mineral density (BMD), minerals in bone, role of osteoblasts and osteoclasts, and more [8:30];
The consequences of poor bone health [13:30];
The devastating nature of hip fractures: morbidity and mortality data [17:00];
Where fractures tend to occur in the body [23:00];
Defining osteopenia and osteoporosis [24:30];
Measuring BMD with DEXA and how to interpret scores [27:00];
Variability in BMD between sexes [34:15];
When should people have their first bone mineral density scan? [36:45];
How BMD changes throughout the life and how it differs between men and women [39:00];
How changes in estrogen levels (e.g., menopause) impact bone health [44:00];
Why HRT is not considered a standard of care for postmenopausal bone loss [47:30];
Factors determining who may be at higher risk of poor bone health [50:30];
Common drugs that can negatively impact BMD [54:15];
How children can optimize bone health and lay the foundation for the future [57:45];
Types of physical activity that can positively impact bone health [1:02:30];
How weight loss can negatively impact bone health and how exercise can counteract those effects [1:10:45];
Nutrition and supplements for bone health [1:14:15];
Pharmaceutical drugs prescribed for those with low BMD [1:17:15];
Impact of extreme sedentary periods (e.g., bedrest) and how to minimize their damage to bone [1:22:00]; and
#165 - AMA #24: Deep dive into blood glucose: why it matters, important metrics to track, and superior insights from a CGM
00:17:22
In this “Ask Me Anything” (AMA) episode, Peter and Bob dive deep into blood glucose and why it matters so much with respect to metabolic health and longevity. They explain the need to pay close attention to metrics like average blood glucose, glucose variability, and peak glucose numbers. Additionally, Peter explains why he encourages all his patients, even nondiabetics, to utilize a continuous glucose monitor (CGM) which gives important insights that traditional lab testing and metrics consistently miss.
If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #24 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
We discuss:
The problem with traditional blood tests and metrics for determining metabolic health [1:10];
The superior insights from a continuous glucose monitor [6:15];
Why lower is better than higher: average glucose, glucose variability, and glucose peaks [12:00];
Deep dive into average blood glucose and the importance of having the lowest average blood glucose possible [14:45];
Deep dive into glucose variability and why less variability is better [33:15];
Example of how HbA1c and traditional measures could catch metabolic issues too late [41:45];
Postprandial dips in blood glucose as a predictor of subsequent hunger and energy intake [43:00];
Exploring the idea that the suppression of fatty acids is actually causing hunger rather than a low blood glucose [49:45];
Deep dive into peak glucose and why lower peaks is better [57:15];
What the best rodent models tell us about the impact of peak glucose levels [1:06:25];
Why Peter encourages all his patients to wear a CGM [1:14:30]; and
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
#67 - AMA #8: DNA tests, longevity genes, metformin, fasting markers, salt, inflammation, and more
00:18:02
In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter’s head of research, asks the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA.
If you’re a subscriber, you can now listen to this full episode on your private RSS feed. You can also watch (or listen) to this full episode on our website at the AMA #8 show notes page.
Questions continue to be pulled from the AMA section on the website, and any subscriber is welcome to submit questions for future AMAs.
We discuss:
Do DNA kits provide actionable info for cancer, CVD, diabetes, Alzheimer’s, nutrition, or exercise? [1:45];
What genes increase longevity? And do those genes show up on genetic tests like 23andMe? [12:00];
Who are some people that Peter would like to have as guests on The Drive? [15:00];
Inflammation: Is CRP a useful marker? What can one do to reduce it? And what other inflammatory markers can I look at to gauge health? [18:30];
What lipid test does Peter now use on his patients? What are the three best cardiovascular laboratories? [28:00];
Metformin for longevity: What considerations should one think about before doing taking metformin for longevity purposes? [32:30];
What is Peter’s take on salt and its role in things like high blood pressure and stomach cancer? [40:00];
What markers does Peter find most interesting (and surprising) during his quarterly fasts? [47:30]; and
Qualy #33 - How silent bravado and incessant striving can lead to a functional (and actual) death, and why Paul is critical of the current state of psychiatry
The Qualysis a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed.Qualysis short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day.The Qualysare short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed onThe Drive.
Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.
Mike Gershon is a Professor of Pathology and Cell Biology at Columbia University and has been at the forefront of studying neural control of the gut for the past 60 years. In this episode, Mike gives a tour de force on the pathways of gut-brain communication but first sets the stage with an overview of gastrointestinal tract development and anatomy. He then explains how the gut communicates with the brain and vice versa, from early observations in physiology and anatomy up to our present understanding of what makes the GI tract so unique and complex relative to other organs. He talks about how the gut responds to meals of different food qualities and how that affects satiety signaling to the brain. Additionally, he explains how antidepressants and other drugs impact digestion through effects on serotonin signaling, and he discusses the effects of antibiotics, and what’s really going on with “leaky gut.” Finally, Mike offers his thoughts on the utility—or lack thereof—of gut microbiome diagnostic tests, and wraps up the discussion by considering how diet, probiotics, and prebiotics impact the microbiome and GI tract.
We discuss:
The basics of the gastrointestinal (GI) system [3:45];
The very early development of the GI system [9:30];
The unique properties of the blood supply and portal system in the GI tract [12:45];
An overview of gut anatomy and innervation [16:30];
Turnover of the epithelial lining and why cancer rarely develops in the small intestine [26:45];
Nutrient and water absorption in the small and large intestine [30:30];
Ways in which the gut and brain communicate [34:30];
The gut's role in the regulation of appetite [43:30];
The impact of gastric bypass surgery on satiety signals [51:15];
How varicella-zoster virus (VZV) can infect neurons in the gut and create issues later in life [54:30];
The relationship between autism and gastrointestinal illness [1:02:45];
The important role of serotonin in the gut, and the impact of SSRIs on serotonin in the gut [1:09:45];
Defining “leaky gut” and its most common causes [1:16:45];
The gut microbiome [1:30:45];
Fecal transplants: use cases, limitations, and how they illustrate the importance of gut microbes [1:40:45];
Gut microbiome diagnostic tests: why they aren’t useful outside of special cases such as cancer detection [1:50:30];
Nutritional approaches to a maintain optimal flora in the gut [1:55:00];
Prebiotics and probiotics, and getting your GI system back on track after a course of antibiotics [2:02:30];
92 - AMA #12: Strategies for longevity (which don't require a doctor)
00:15:03
In this “Ask Me Anything” (AMA) episode, Peter explains the various levers one can pull to affect longevity with a specific focus on the strategies and tactics one can implement that do not require the help of a physician. Once again, Bob Kaplan, Peter's head of research, will be asking the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA.
#327 - Choices, costs, and challenges in US healthcare: insurance intricacies, drug pricing, economic impacts, and potential reforms | Saum Sutaria, M.D.
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
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
#161 - AMA #23: All Things Nicotine: deep dive into its cognitive and physical benefits, risks, and mechanisms of action
00:19:53
In this “Ask Me Anything” (AMA) episode, Peter and Bob dive deep into nicotine, a complicated and interesting molecule that has effects on both the brain and the body. They analyze the results of the studies that describe nicotine’s cognitive benefits and potential for inducing weight loss. They talk about a smoking cessation technique called nicotine replacement therapy and give a full breakdown of the various routes of administration, dosing, and safety. Finally, they explore the fascinating and counterintuitive observation that cigarette smokers are less likely to get a severe case of COVID-19.
If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #23 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
We discuss:
How Peter first became interested in the potential benefits of nicotine [1:15];
Untangling nicotine from tobacco [6:00];
Nicotine replacement therapy (NRT) for quitting smoking: products, protocols, and a review of the literature [9:30];
The cognitive benefits of nicotine: Overview of the literature [15:50];
Where nicotine has the most positive impact on cognition [30:30];
Possible mechanisms conferring the benefits of nicotine [37:00];
How modafinil and other nootropics compare to nicotine [47:15];
How nicotine may induce weight loss [54:00];
Relationship between smoking and COVID-19: Analyzing the observation that smoking appears protective against COVID-19 [1:01:45];
Breakdown of the various nicotine replacement therapies: route of administration, dosing, and safety [1:11:30];
Concluding thoughts on nicotine: use cases, addictive properties, and more [1:19:45]; and
Rick Johnson, Professor of Nephrology at the University of Colorado and a previous guest on The Drive, returns for a follow-up about unique features of fructose metabolism, and how this system that aided the survival of human ancestors has become potentially hazardous based on our culture’s dietary norms. In this episode, Rick explains how the body can generate fructose from glucose and how circulating glucose and salt levels can activate this conversion. He discusses the decline in metabolic flexibility associated with aging, as well as how factors such as sugar intake or menopause-associated hormone changes can alter responses to sugar across a lifetime. In addition, Rick lays out strategies for combating the development of metabolic illness using dietary changes and pharmaceutical therapies, and he discusses the impact of fructose metabolism and uric acid on kidney function and blood pressure. He concludes with a discussion of vasopressin, a hormone that facilitates fructose’s effects on weight gain and insulin resistance.
We discuss:
Unique features of fructose metabolism and why it matters [2:45];
A primer on fructose metabolism and uric acid [10:30];
Endogenous fructose production, the polyol pathway, and the effect of non-fructose sugars [22:00];
Findings from animal studies of glucose and fructose consumption [29:00];
What calorie-controlled studies say about the claim that a “calorie is a calorie” [42:15];
Implications for aging and disease [51:15];
Impact of endogenous fructose production on obesity and metabolic syndrome [1:01:30];
Why vulnerability to the negative effects of sugar increases with age and menopause [1:04:30];
Dietary strategies to reduce the negative impact of fructose [1:16:30];
The role of hypertension in chronic disease and tips for lowering blood pressure [1:30:45];
The impact of fructose and uric acid on kidney function and blood pressure [1:39:45];
The potential role of sodium in hypertension, obesity, and metabolic syndrome [1:49:00];
The role of vasopressin in metabolic disease [1:54:00];
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
#48 – Matthew Walker, Ph.D., on sleep – Part II of III: Heart disease, cancer, sexual function, and the causes of sleep disruption (and tips to correct it)
02:04:32
In part 2 of this 3 part series, Matthew Walker, professor of neuroscience at UC Berkeley and expert on sleep, describes the preponderance of evidence linking poor sleep to cardiovascular disease, cancer, and sexual function. He also details the impact of cortisol on our nervous system contributing to sleep disturbances and insomnia as well as the efficacy and risks associated with the most common sleeping pills. Matthew also describes the sleep needs of teenagers and urgently lays the case that we should reconsider school start times. We also get into the effect of electronics at night, the efficacy of napping, the general impact of modern society on our sleep habits, and what changes we can make to course correct.
We discuss:
Sleep and cardiovascular disease [6:00];
Fuel partitioning and dieting while sleep deprived [16:45];
Sleep and the reproductive function: testosterone, sperm count, FSH, menstrual cycles, and fertility [19:45];
The biological necessity of sleep, the lack of a “safety net”, sleep debt, and ways to course correct sleep problems [23:45];
Fighting cancer and improving immune function with sleep [34:30];
The medical profession: A culture that devalues sleep [47:30];
The sleep needs of children, the travesty of early school start times, electronics at night, and advice for parents [1:04:45];
How exposure to light affects sleep, and how modern society has changed our sleep habits [1:26:15];
Is napping helpful? [1:36:00];
The effect of cortisol levels on sleep [1:41:15];
Are sleeping pills doing more harm than good? [1:52:15]; and
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];
#166 - Patricia Corby, D.D.S.: Importance of oral health, best hygiene practices, and the relationship between poor oral health and systemic disease
02:00:37
Dr. Patricia Corby is Associate Professor of Oral Medicine and Associate Dean of Translational Research at Penn Dental Medicine. Her work focuses on the importance of providing dental services alongside critical public healthcare services, like cancer treatment. In this episode, Pat provides an overview of dental anatomy, the importance of oral hygiene to overall health, and the association of poor oral health and systemic diseases like cancer and diabetes. She addresses tooth decay, oral hygiene in children, the utility of dental products, and ideal oral care regimens for different populations. She also discusses issues specific to immunocompromised patients and those with chronic illnesses as well as her own research with cancer patients undergoing radiation treatment.
We discuss:
Anatomy of teeth and the purpose of the dental pulp—a highly vascularized and innervated region of the tooth [3:00];
Types of teeth and the different purpose they serve [14:15];
Anatomy of the oral cavity, bacteria in the mouth, and what a healthy mouth looks like [18:10];
Pat’s study demonstrating the importance of flossing [23:00];
Detrimental effects of sugar and the importance of fluoride and oral hygiene [31:45];
Oral health challenges for cancer patients and immunocompromised people [39:45];
Pat’s current research on cancer patients undergoing radiation treatment and the oral health risks associated with human papilloma virus (HPV) [50:00];
Periodontal disease: caries and root canals [57:30];
The relationship between poor oral health and systemic health diseases [1:11:00];
Potential connection between oral hygiene and COVID-19 [1:17:45];
Dry mouth leading to oral infections and ways to prevent it [1:22:30];
What determines the appearance of teeth, methods of teeth whitening, and whether you should remove mercury fillings [1:27:30];
Importance of fluoride for preventing tooth decay, and dental care for children [1:32:45];
Useful dental products: floss, electrics toothbrushes, and more [1:39:15];
#186 - Patrick Radden Keefe: The opioid crisis—origin, guilty parties, and the difficult path forward
01:55:56
Patrick Radden Keefe is an award-winning staff writer at The New Yorker and the bestselling author of Empire of Pain: The Secret History of the Sackler Dynasty. In this episode, Patrick tells the story of the Sackler family and Purdue Pharma - makers of the pain management drug OxyContin, providing the backdrop for the ensuing opioid epidemic and public health crisis. He reveals the implicit and sometimes explicit corruption of all parties involved in the development, approval, and marketing of OxyContin, leading to a cascade of unintended consequences including addiction and death. He explains the unfortunate lack of accountability for the current crisis, as well as what it all means for those with legitimate pain management needs. Finally, he examines the difficult path ahead towards finding a solution.
We discuss:
Patrick’s investigation into distribution and use of drugs in our society [3:55];
The scale of the opioid crisis [9:15];
The Sackler brothers: family life, career in the pharmaceutical industry, and role in the current crisis [11:45];
Purdue Pharma: origins, early years, and move towards pain management drugs [17:30];
The development of OxyContin: its conception, marketing, and the controversy around the FDA approval process [25:30];
Early reports of OxyContin addiction and unintended consequences and how Purdue Pharma sidestepped responsibility [40:45];
The many paths to addiction and abuse of OxyContin and the ensuing downfall of Purdue Pharma [47:15];
Peter’s personal experience with OxyContin [57:00];
Pain—the “fifth vital sign,” how doctors are trained in pain management, and the influence of money [1:08:00];
Other players that helped facilitate the eventual opioid crisis [1:16:15];
Lack of accountability following the investigation and prosecution of Purdue and the Sackler family [1:23:30];
Legacy of the Sackler family and their disconnect from reality [1:34:45];
Patrick’s views on the regulation and use of pain management drugs [1:42:15];
#91 – Eric Topol, M.D.: Can AI empower physicians and revolutionize patient care?
02:01:03
In this episode, Dr. Eric Topol, founder and director of the Scripps Research Translational Institute, shares how artificial intelligence and deep learning is currently impacting medicine and how it could transform the healthcare industry, not only in terms of the technological advancements, but also in restoring the patient-doctor relationship for better patient outcomes and experiences. We also discuss Eric’s rich and fascinating career in cardiology as well as his involvement as one of the first outspoken researchers to question the cardiovascular safety of Vioxx.
We discuss:
Eric’s background and his source of interest in cardiology [3:15];
The US medical field’s resistance to technological change and learning from other healthcare models [11:15];
Eric’s mission at the Cleveland Clinic [20:15];
How Eric helped to elucidate the issues with Vioxx (and why he came to regret it) [29:45];
How Eric came to found one of the most influential research centers in the world [47:30];
How AI and deep learning is currently impacting medicine, and the future possibilities [56:30];
Gut microbiome—Its role in health, impact on glycemic response and fuel partitioning, and how deep learning could improve our research and treatment [1:17:45];
Why machines combined with human doctors is superior to one without the other [1:32:00];
How AI and machines can reinstate medicine as an attractive career (and alleviate physician burnout) [1:36:45];
This episode is a follow-up to our recent COVID-19 podcast with Drs. Marty Makary and Zubin Damania (aka ZDoggMD). Here, we address many of the listener questions we received about our original discussion. In addition to Marty and ZDoggMD, we are also joined by Dr. Monica Gandhi, an infectious disease specialist and Professor of Medicine at the University of California, San Francisco. In this episode, we talk about new data on Omicron, long COVID, masks, kids and schools, vaccine mandates, policy questions, and treatments. We also discuss some of the most prevalent misinformation and spend time talking about claims made by Robert Malone. We end with a conversation about our exit strategy.
Please note: we recorded this episode on January 17, 2022, and in an effort to get it out as soon as possible, this won’t have full show notes or a video. Additionally, Monica was only able to join us for the first section of the podcast, so you’ll hear her drop off partway through.
We discuss:
Severity of infection from Omicron—reviewing the data [5:15];
Factors contributing to the relative mildness of Omicron infections [8:30];
Is SARS-CoV-2 evolving to cause less severe disease? [13:00];
Potential of Covaxin—an inactivated virus-based COVID-19 vaccine [17:45];
How B cells and T cells work together to defend against viruses [22:00];
Comparing COVID-19 vaccines, and the rationale for the time between doses [25:30];
Reviewing the purpose and effectiveness of boosters for reducing severity and transmission [32:30];
Debating vaccine mandates, and putting COVID’s mortality risk in perspective [41:00];
Why the topic of COVID has become so polarized [1:03:15]
Reviewing the data on masks for protecting oneself and protecting others [1:06:30];
The inconsistent logic used for mask mandates [1:16:00];
Long COVID and the potential for vaccines to reduce risk [1:21:45];
Risks for children and policies for schools [1:27:30];
Reviewing the outcomes from Sweden, where the government didn't impose lockdowns [1:31:00];
Draconian measures implemented in Canada [1:38:15];
Antiviral treatments for COVID and a common-sense approach [1:42:15];
Importance of ending tribalism and having rational discussions with humility [1:47:30];
Treating infection with monoclonal antibodies and convalescent sera [2:01:45];
Reviewing claims made by the controversial Dr. Robert Malone [2:11:15];
A potential exit strategy from the current situation [2:30:30];
In this “Ask Me Anything” (AMA) episode, Peter dives deep into nicotine—a topic increasingly debated both scientifically and publicly. He clarifies the critical differences between nicotine and tobacco, highlighting why nicotine alone isn't primarily responsible for smoking's severe health consequences. Peter examines the specific risks associated with nicotine use, including addiction, sleep disruption, cardiovascular concerns, and effects on mood and anxiety. He evaluates various nicotine delivery methods, from traditional cigarettes to gums, pouches, and synthetic alternatives, ranking them according to their relative safety. Additionally, Peter explores nicotine's potential positive and negative impacts on physical performance, cognitive function, fertility, and its interactions with other stimulants like caffeine. Finally, he provides practical guidance for minimizing risks with nicotine use and offers thoughtful strategies for smoking cessation and effective nicotine replacement therapies.
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 #70 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
We discuss:
Revisiting the previous AMA on microplastics: low-effort, high-impact changes to significantly reduce microplastic exposure [1:45];
Overview of episode topics related to nicotine [3:30];
The current landscape of nicotine research [4:45];
Addressing the common misconception that nicotine itself is the primary cause of tobacco-related health risks [6:45];
Peter’s Marlboro-branded apparel is a nostalgic tribute to the Formula One era and not a sign of support for smoking [10:00];
The limitations of current research on the health risks of nicotine itself [12:15];
The most common side effects of nicotine [18:15];
The impact of nicotine on sleep [21:30];
Nicotine and mood: how nicotine can have both anxiety-inducing and calming effects based on genetics and dosage [25:00];
The addictive properties of nicotine: factors influencing addiction risk, and why certain people may struggle more than others [29:15];
The various nicotine products and nicotine delivery methods available: effects, absorption rates, and potential risks [33:45];
The relative risks of various nicotine products: how differences in nicotine concentration, absorption rates, and presence of contaminants impact their safety [37:00];
Potential cognitive benefits of nicotine: short-term benefits and impact of chronic use [44:45];
How nicotine exposure during adolescence can negatively impact brain development [47:45];
Nicotine's potential to prevent or slow neurodegenerative diseases [50:45];
Nicotine’s impact on memory, learning, and attention [52:45];
The interaction between nicotine and other stimulants, particularly caffeine [55:15];
Nicotine's potential impact on physical performance [57:15];
The potential effects of nicotine on fertility, and the challenges of distinguishing the impact of nicotine itself from the effects of smoking [58:30];
Considerations for people curious about using nicotine for its cognitive benefits [1:01:30];
How to think about nicotine: weighing cognitive claims, addiction risks, and personal tolerance [1:03:15];
The prevalence of smoking, the health risks it poses, and the substantial long-term benefits of quitting [1:05:45];
Effective strategies for smoking cessation, including the use of nicotine replacement therapies [1:09:00];
The reasons behind weight gain after quitting smoking, the role of nicotine in appetite suppression, and strategies to manage weight [1:15:30]; and
In this “Ask Me Anything” (AMA) episode, Peter dives into two important health topics: uric acid and protein, examining them from unique perspectives. For uric acid, he explores its metabolic role and connection to various diseases, focusing on the potential causal link with cardiovascular disease. He also discusses factors influencing uric acid levels, such as diet, genetics, and lifestyle, providing practical tips for effective management. Shifting to protein, Peter delves into its role in appetite and weight management, the consequences of insufficient protein, and the “protein leverage hypothesis” linking protein deficiency to obesity. He covers optimal protein intake and its impact on energy expenditure, and he compares the satiety effects of solid versus liquid protein. Finally, Peter shares his strategy for incorporating protein into a comprehensive weight management plan.
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 #62 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 an important discussion on fanny packs) [2:00];
Understanding uric acid: its role in metabolic processes, its association with gout and kidney stones, its impact on blood pressure, and more [6:00];
Non-modifiable factors that influence uric acid levels [11:00];
Modifiable factors that influence uric acid levels [14:15];
Association between high uric acid levels and cardiovascular disease [20:00];
Evidence suggesting a causal link between high uric acid levels and cardiovascular disease [24:00];
Inconclusive evidence about the cardiovascular benefits of lowering uric acid pharmacologically [28:15];
Exploring the potential risks of low uric acid levels in neurodegenerative diseases [37:00];
Managing uric acid levels: dietary interventions and pharmacological approaches [42:00];
The impact of protein on appetite and weight management [44:00];
The consequences of insufficient protein on eating behaviors and satiety [52:15];
The relationship between protein deficiency and obesity: exploring the “protein leverage hypothesis” [57:15];
The impact of protein intake on energy expenditure [1:02:15];
Determining optimal protein intake to avoid deficiency and support health [1:05:45];
The role of different amino acids and protein sources in promoting satiety [1:08:15];
Comparing the satiety effects of solid vs. liquid protein sources [1:10:30];
Peter’s framework for incorporating protein intake into a strategy for controlling body weight [1:12:00]; and
Marty Makary, a Johns Hopkins surgeon and New York Times bestselling author, returns to The Drive to discuss his latest book, Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health. In this episode, Marty explores how a new generation of doctors is challenging long-held medical practices by asking critical new questions. He discusses the major problems of groupthink and cognitive dissonance in the medical community and delves into several of the "blind spots" raised in the book, including treatments for appendicitis, the peanut allergy epidemic, misunderstandings about HRT and breast cancer, antibiotic use, and the evolution of childbirth. He explains the urgent need for reform in medical education and the major barriers standing in the way of innovative medical research. Throughout the conversation, Marty offers insightful reflections on where medicine has succeeded and where there’s still room to challenge historic practices and embrace new approaches.
We discuss:
The issue of groupthink and cognitive dissonance in science and medicine [2:30];
How a non-operative treatment for appendicitis sheds light on cognitive dissonance [7:00];
How cognitive dissonance and effort justification shape beliefs and actions [13:15];
How misguided peanut allergy recommendations created an epidemic [17:45];
The enduring impact of misinformation and fear-based messaging around hormone replacement therapy allegedly causing breast cancer [25:15];
The dangers of extreme skepticism and blind faith in science, and the importance of understanding uncertainty and probability [28:00];
The overuse of antibiotics and the rise of antibiotic resistant infections and poor gut health [33:45];
The potential correlations between early antibiotic use and chronic diseases [40:45];
The historical and evolving trends in childbirth and C-section rates [50:15];
Rethinking ovarian cancer: recent data challenging decades of medical practice and leading to new preventive measures [1:05:30];
Navigating uncertainty as a physician [1:19:30];
The urgent need for reform in medical education [1:21:45];
The major barriers to innovative medical research [1:27:30];
The dogmatic culture of academic medicine: why humility and challenging established norms are key for progress [1:38:15];
The major successes and ongoing challenges of modern medicine [1:51:00]; and
#20 - Thomas Dayspring, M.D., FACP, FNLA – Part I of V: an introduction to lipidology
01:14:28
In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. Part I serves as an introduction to Tom, his work, and an overview of lipid terminology.
We discuss:
Tom’s recent and remarkable physical transformation [6:30];
The moving stories behind Tom’s obsessions: firefighting, hockey, and, of course, lipids [20:30];
Tom’s medical background [39:30];
Producing some of the most accessible diagrams on lipids [50:00];
What are the different kinds of lipids, what do they do, and how are they transported? [57:15]; and
#57 – Rick Rubin, legendary music producer: collaborating with sensitive psyche of greatest living musicians, and his personal story of weight loss and spiritual quest
03:03:53
In this episode, Rick Rubin, legendary music producer and co-founder of Def Jam Records and American Recordings, discusses his early foray into music production which started as a hobby as a teenager and ultimately turned into a Grammy award-winning career that produced revolutionary changes in the music industry. Rick has worked with the likes of the Beastie Boys, Red Hot Chili Peppers, and Johnny Cash, just to name a small fraction. Rick talks about the pain and suffering that sometimes drives music and the cycle of drug addiction and how he has been able to help artists through those struggles to make space for their creative genius. We also get into Rick’s own personal health journey including his battle with depression, his struggle with obesity, and ultimately his extraordinary transformation. Finally, Rick shares a really significant health scare which required emergency heart surgery, and how that experience has impacted him.
We discuss:
Early career, and the birth of hip hop [7:15];
Early success of Def Jam Recordings, and working with LL Cool J [13:15];
Revolutionary changes in music: LL Cool J, Beastie Boys, and Run DMC [19:30];
Partnership with Columbia Records, and leaving Def Jam [26:45];
The success of Licensed to Ill: how it took off, and how it changed things [36:00];
American Recordings: Rick’s transition to rock and roll [39:15];
Working with the Red Hot Chili Peppers, and the poetic nature of music [45:45];
Rick’s favorite music that he did NOT produce [53:00];
Prevalence of drug use and emotional pain in musicians: Rick’s experience with helping artists through their struggles [57:20];
NYC vs. LA hip hop [1:05:30];
Rick’s battle with depression [1:10:00];
Coping with the death of artists that Rick worked with [1:22:00];
Working with Johnny Cash [1:26:45];
Working with Rage Against the Machine [1:34:30];
The digital age of music: Have we lost something? [1:37:45];
Rick’s health journey and battle with obesity [1:42:45];
Radical weight loss: How Rick was finally able to shed the weight [2:00:15];
Total transformation: Exercise and training with Laird Hamilton [2:11:00];
In this “Ask Me Anything” (AMA) episode, Peter and Bob explore the quality of evidence for hot and cold therapy. In the discussion, they evaluate the safety, efficacy, and opportunity costs of various hot and cold therapy protocols, and Peter ultimately considers the addition of dry sauna to his longevity toolkit. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #16 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
We discuss:
How stress can show up as physical pain, and tips for changing time zones [1:45];
Literature overview of heat and cold therapy [7:15];
Cold therapy for delayed onset muscle soreness (DOMS) [12:00];
Quality of evidence for cold therapy for depression or immune enhancement [19:30];
Cold therapy and brown adipose tissue (BAT) [21:15];
Weighing the safety, efficacy, and opportunity cost of cold therapy [28:45];
An overview of heat therapy benefits [40:00];
Longevity benefits of sauna—reviewing the studies [41:30];
Limitations in the sauna literature—Where might we be fooled? [54:30];
Possible mechanisms conferring the longevity benefits of sauna, and how it compares to exercise [1:02:15];
Parting thoughts on sauna, opportunity costs, and Bob’s personal regimen [1:06:30]; and
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 [3:15];
A missed experience and feeling of regret that shaped Bill’s thinking [14:15];
Thinking in terms of time, and the relationship between money, time, and health [17:00];
Solving for net fulfillment and allocating your time based on the seasons of life [27:15];
How Bill thinks about risk, opportunity costs, and the difference between fear and risk tolerance [35:30];
Optimizing for fulfillment, finding purpose outside of work, and more [41:45];
Thinking about the order of experiences you want to have based on seasons of life [50:00];
Bill’s unique perspective on philanthropy and a more impactful way to give money away [54:45];
Applying the principles in ‘Die With Zero’ to maximize fulfillment [1:04:00];
How to break out of living life on autopilot [1:14:30];
When should your net worth peak? [1:18:00];
Taking calculated risks [1:21:30];
Bill shares a lesson from his incredible birthday [1:25:15];
How Bill’s philosophy has evolved since writing Die With Zero [1:34:00]; and
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
Celia Morgan is a Professor of Psychopharmacology at the University of Exeter who has authored numerous publications on the potential therapeutic uses of ketamine in mental healthcare. In this episode, Celia dives deep into the neurobiology of ketamine, how it affects users, and how it differs from other, more classical psychedelics (LSD, MDMA, PCP, and psilocybin). She explains the potential promise of ketamine as a treatment for recalcitrant depression and addiction, and she details the results from her clinical trials in these areas. She discusses the importance of using ketamine in combination with psychotherapy to maximize its benefits, the potential risks associated with ketamine use, and advice for those interested in the therapeutic use of ketamine.
We discuss:
Celia’s training and interest in ketamine [2:15];
The history of ketamine, medical uses, and use as a party drug [3:30];
Neurobiology and pharmacology of ketamine [8:15];
Ketamine regulation and abuse, and how it compares with psychedelics and other molecules [18:15];
Ketamine as a therapeutic for depression [30:45];
The brain under the influence of ketamine and theoretical mechanisms for its anti-depressive effects [48:00];
Risks and concerns with overusing ketamine, and what an intermittent or maintenance dose might look for a patient [57:15];
Treating addiction with ketamine: Celia’s studies of alcohol dependance [1:04:00];
Advice for people considering the therapeutic use of ketamine [1:19:45];
#142 - Robert Abbott: The Bobby Knight story—a cautionary tale of unchecked anger, ego, and winning at all costs
02:14:25
Robert Abbott is a six-time Emmy award winner and the director of “The Last Days of Knight,” the behind-the-scenes documentary of legendary coach Bobby Knight, and the events that led to his termination from Indiana University. In this episode, Robert takes us through his investigative journey, which revealed cautionary tales of a winning at all costs environment—how pain often gets left in the wake of unchecked anger, ego, and perfectionism. Robert reflects on Knight’s legacy and extracts lessons in self-awareness and accountability that can be applied to ensure history doesn’t repeat itself.
We discuss:
Robert’s career covering sports and interesting athletes (2:30);
Robert’s early impression of Bobby Knight’s controversial persona (10:15);
The journalistic work that uniquely prepared Robert for his Bobby Knight story (13:30);
The cost of excellence in sports—cautionary tales of ‘greatness at any cost’ (19:15);
Knight’s coaching style, waning success in the 90s, and what put him on Robert’s radar (25:30);
Three alarming accounts from a former player (Neil Reed) that launched Robert’s investigation into Bobby Knight (35:15);
The “win-first” environment at Indiana that provided cover for Knight’s toxic behavior (44:45);
Knight’s ego swells—a shift from team-first to “I” and “me” (53:00);
How patience, honesty, and gaining trust with his sources paid off in his reporting on Bobby Knight (1:01:30);
The vicious cycle and anger and shame, and why Bobby Knight is so interesting to Peter (1:08:00);
Releasing the choking tape—Breaking open the Knight story, vindicating his earlier reporting, and the most powerful moment Robert has ever witnessed in his journalistic career (1:20:00);
The bittersweet story of Neil Reed—triumph, PTSD, and breaking the cycle of pain (1:43:15);
Examining Bobby Knight's legacy, and how society can avoid a repeat of similar devastating situations (1:57:30);
Final thoughts on Bobby Knight and the pain left in his wake (2:08:00); and
#169 - Katherine Eban: COVID-19 Lab Leak: Examining all sides of the debate and discussing barriers to a full investigation
01:39:43
Katherine Eban is an award-winning investigative journalist who previously appeared on The Drive to discuss the widespread fraud in the generic drug industry. In this episode, she discusses the content of her recent Vanity Fair article, which examined the evidence for the theory that the COVID-19 pandemic resulted from a virus lab escape as opposed to a natural virus that came from an animal host. Katherine and Peter walk through the evidence for both theories as well as discuss the long and troubling history of dangerous lab leaks and safety concerns about the Wuhan Institute of Virology. They also talk about the controversy surrounding gain-of-function research and its funding by the US government. Finally, they conclude with a discussion on the likelihood of definitively establishing the origins of the virus given the Chinese government’s lack of cooperation and highlight the fact that the many barriers to performing a full investigation may be the most troubling aspect of the controversy. This episode was originally recorded on July 6, 2021.
We discuss:
An overview of the lab leak controversy [1:30];
The troubling history of lab leaks of dangerous pathogens [8:30];
The zoonotic transmission theory: did SARS2 come from a bat? [11:45];
The debate about gain-of-function (GoF) research [26:15];
Questions about US funding of GoF research in China [33:45];
The uncertain significance of the furin cleavage site [51:30];
Discerning what’s most important about both the zoonotic transmission and lab leak theories [1:01:15];
The Qualysis a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed.Qualysis short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day.The Qualysare short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed onThe Drive.
Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.
Layne Norton holds a Ph.D. in nutritional sciences and is a physique coach, natural bodybuilder and powerlifter, and two-time previous podcast guest. In this episode, Layne discusses his training as a powerlifter and shares training principles that non-powerlifters can apply to improve muscle strength and mass. Layne goes in-depth on creatine supplementation, including the benefits for lean mass and strength, and addresses the common arguments against its regular usage. Additionally, Layne touches on many areas of nutrition, including how his opinions have changed on certain topics. Layne also touches on the subjects of protein, fiber, and fat in the diet, as well as the different tools and dietary approaches for energy restriction.
We discuss:
The sport of powerlifting and Layne’s approach during competitions [2:30];
Training for strength: advice for beginners and non-powerlifters [13:15];
Low-rep training, compound movements, and more tips for the average person [23:15];
How strength training supports longevity and quality of life: bone density, balance, and more [28:15];
Peak capacity for strength as a person ages and variations in men and women [33:00];
Effects of testosterone (endogenous and exogenous) on muscle gain in the short- and long-term [36:45];
How Layne is prepping for his upcoming IPF World Masters Powerlifting competition [44:00];
Creatine supplementation [54:30];
How important is rep speed and time under tension? [1:05:30];
Validity of super slow rep protocols, and the overall importance of doing any exercise [1:12:45];
Navigating social media: advice for judging the quality of information from “experts” online [1:23:00];
Layne’s views on low-carb diets, the tribal nature of nutrition, and the importance of being able to change opinions [1:34:45];
Where Layne has changed his views: LDL cholesterol, branched-chain amino acid supplementation, intermittent fasting, and more [1:42:00];
The carnivore diet, elimination diets, and fruits and vegetables [1:55:15];
Fiber: Layne’s approach to fiber intake, sources of fiber, benefits, and more [2:00:15];
Confusion around omega-6 polyunsaturated fatty acids and the Minnesota Coronary Experiment [2:05:00];
Layne’s views on fats in the diet [2:13:00];
Flexible dieting, calorie tracking, and the benefits of tracking what you eat to understand your baseline [2:18:00];
The nutritional demands of preparing for a bodybuilding show [2:30:45];
The psychological effects of aging and changes to one’s identity [2:42:00]; and
The Qualysis a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed.Qualysis short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day.The Qualysare short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed onThe Drive.
Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.
#101 - Ryan Holiday: Finding stillness amidst chaos
01:22:44
Ryan Holiday, bestselling author and author of Daily Stoic, discusses practical ways to find stillness and apply the insights of stoic philosophy in the midst of COVID-19 chaos. Ryan discusses the importance of taking back a feeling of control, the benefits of structure and routine, and the idea of being prepared for anything.
We discuss:
Using times of adversity to evaluate and reflect how you’ve set up and prioritized your life [2:30];
What insights might the famous stoics provide amidst this COVID-19 pandemic? [8:15];
The possible consequences of the socially isolating nature of a pandemic (and why we need good leaders) [13:00];
Stoicism—what it means and how to apply it [18:45];
Lessons taken from the life of Winston Churchill—stillness, structure, routine, hobbies, empathy, forward thinking, and more [23:30];
Alive time vs. dead time—taking control of your time and making it count [38:45];
Auditing how the world (and its leaders) are handling the COVID-19 pandemic through the lens of stoic philosophy [44:15];
Asserting control and using routine to find stillness in an environment not conducive for it [52:15];
Why you should find a way to exercise, especially now [58:30];
How to find purpose during this time—goal setting, having a project to work on, and the benefits of keeping a journal [1:02:00];
What is Ryan most optimistic about and what is he most concerned about over the next few months? [1:08:45];
How can you follow Ryan’s work and messages about stoicism and stillness? [1:17:45].
In this “Ask Me Anything” (AMA) episode, Peter is joined by special guest, Dr. Matt Kaeberlein. Together they answer many questions around the field of aging with an emphasis on three specific molecules—NAD, metformin, and rapamycin—and their purported geroprotective qualities. They first discuss aging biomarkers and epigenetic clocks before breaking down the advantages and limitations of the most common experimental models being used today to study aging and pharmacological possibilities for extending lifespan. Next they dive deep into NAD and the much-hyped NAD precursors, nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN). They compare data from NAD precursors to studies on metformin and rapamycin, assessing how they stack up against each other and using the comparison as an opportunity to illustrate how to make sense of new experimental data and make smart decisions about how to approach future research.
If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #35 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
We discuss:
Logic behind comparing NAD precursors to rapamycin and metformin [3:40];
Aging biomarkers: current state, usefulness, and future promise [7:00];
Epigenetic clocks: definition, use case, and limitations [14:45];
Advantages and limitations of studying aging in non-humans and the strengths and weaknesses of different model systems [26:30];
Aging studies: importance of control lifespans and the problems with reproducibility [34:15];
Intro to NAD, potential role in aging, relationship to sirtuins, and more [48:15];
NAD precursors (NR and NMN): current data [1:10:00];
Human studies with NAD precursors [1:25:45];
Comparing NAD lifespan data to data from metformin and rapamycin [1:28:30];
Defining a “clean drug” and a “dirty drug” [1:38:00];
Reason for the lack of rapamycin studies in humans compared to NAD and metformin [1:41:00];
Ranking the geroprotective molecules in terms of risk and reward [1:48:00]; and
#272 ‒ Rapamycin: potential longevity benefits, surge in popularity, unanswered questions, and more | David Sabatini, M.D., Ph.D. and Matt Kaeberlein, Ph.D.
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
Alton Barron is an orthopedic surgeon specializing in the shoulder, elbow, and hand. In this episode, Alton breaks down the anatomy of the upper extremities and discusses the most common injuries associated with this area of the body. He explains in detail how he examines the shoulder, elbow, and hand to find the source of the pain and lays out the non-surgical and surgical treatment options as well as the factors that determine whether surgery is appropriate. Additionally, Alton describes the surgical procedures that, when done appropriately, can lead to tremendous reduction of pain and improvement in function.
We discuss:
Alton’s path to orthopedic surgery [3:45];
Evolution of orthopedics and recent advances [8:45];
Anatomy of the upper extremities [13:30];
Rotator cuff injuries, shoulder joint dislocation, and more [21:15];
Peter’s shoulder problems [31:30];
The structure of the biceps and common injuries [35:30];
Labrum tears in the shoulder and natural loss of cartilage with usage and time [38:15];
Shoulder evaluation with MRI vs. physical exam, diagnosing pain, and when to have surgery [41:30];
How anatomical variation can predispose one to injury and how screening may help [50:30];
Pain generators in the shoulder, and the important nuance of the physical exam [56:00];
Frozen shoulder [1:05:15];
Shoulder pain that originates in the neck [1:11:15];
Surgical treatments for a labral tear, and factors that determine whether surgery is appropriate [1:16:00];
Repairing the rotator cuff [1:29:15];
Are platelet-rich plasma (PRP) injections or stem cells beneficial for healing tears? [1:38:15];
Repair of an AC joint separation [1:45:15];
Total shoulder replacement [1:55:45];
The elbow: anatomy, pain points, common injuries, treatments, and more [2:05:30];
How Tommy John surgery revolutionized Major League Baseball [2:17:15];
History of hand surgery and the most significant advancements [2:22:15];
The hand: anatomy, common injuries, and surgeries of the hand and wrist [2:29:30];
Carpal tunnel syndrome [2:40:00];
Other common injuries of the hand and forearm [2:47:15];
Grip strength [2:55:15];
Arthritis in the hands [2:59:30];
Trigger finger [3:07:45];
Nerve pain, numbness, and weakness in the upper limbs [3:14:00];
In this “Ask Me Anything” (AMA) episode, Peter delves into the often misunderstood concept of inflammation. He first defines inflammation and differentiates between acute inflammation and chronic inflammation, the latter of which is linked to aging and a plethora of age-related diseases. Peter breaks down the intricate relationship between chronic inflammation, obesity, and metabolic health, and highlights the signs that might suggest someone may be suffering from chronic inflammation. From there, the conversation centers on actionable advice and practical steps one can take to manage and minimize chronic inflammation. He explores how diet plays a crucial role, including the potential benefits of elimination diets, and he examines the impact of lifestyle factors such as exercise, sleep, and stress management. Additionally, he discusses the relevance of food inflammatory tests and concludes by examining the potential benefits and drawbacks of drugs and supplements in managing inflammation.
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 #59 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
We discuss:
Defining inflammation (and the cultural impact of Napoleon Dynamite) [1:45];
Acute vs chronic inflammation [8:00];
The connection between chronic inflammation, aging, and age-related diseases [11:00];
The impact of inflammation on metabolic health [18:30];
Understanding and diagnosing chronic inflammation: blood tests and other approaches, and challenges with measurement [20:00];
Factors that contribute to low-level chronic inflammation [28:00];
Minimizing inflammation through diet [29:45];
The important role of fiber for gut health and inflammation [33:45];
A closer look at the impact of trans fats and saturated fats on overall health [34:45];
Why Peter prefers dietary fiber from food sources over supplements [38:30];
Debunking “superfoods”: emphasizing proven methods over marketing claims for reducing inflammation [39:00];
Is there any value in over-the-counter food inflammatory tests? [42:30];
Food elimination diets: how they work, symptoms and markers to watch, challenges and limitations [45:15];
Identifying dietary triggers for gut-related symptoms through low-FODMAP diets like the “carnivore diet” [51:15];
Dairy: the complex role of dairy on inflammation and individual responses [55:00];
Wheat: the complexities and conflicting evidence around wheat's inflammatory effects [57:45];
How exercise influences inflammation [1:02:00];
How sleep quality and duration impacts inflammation [1:07:00];
The potential impact of chronic psychological stressors on inflammation [1:13:00];
The impact of oral health on inflammation and overall well-being [1:15:00];
The role of medications in managing chronic inflammation [1:18:15];
Supplements: evaluating the efficacy of various anti-inflammatory supplements [1:22:15];
#189 - COVID-19: Current state of affairs, Omicron, and a search for the end game
02:45:14
In this episode, Peter sits down with Drs. Marty Makary and Zubin Damania (aka ZDoggMD), both previous guests on The Drive. Marty is a Johns Hopkins professor and public health researcher and ZDoggMD is a UCSF/Stanford trained internist and the founder of Turntable Health. This episode, recorded on December 27, 2021, was in part inspired by some of the shoddy science and even worse messaging coming from top officials regarding COVID-19. In this discussion, Marty and ZDoggMD discuss what is known about the omicron variant, the risks and benefits of vaccines for all age groups, and the taboo subject of natural immunity and the protection it offers against infection and severe disease. Furthermore, they discuss at length the poor messaging coming from our public officials, the justification (and lack thereof) for certain mandates and policies in light of the current evidence, and the problems caused by the highly politicized and polarized nature of the subject. Themes throughout the conversation include the difference between science and advocacy, the messaging which is sowing mistrust in science despite major progress, and a search for what a possible “end” to this situation might look like.
NOTE: Since this episode was recorded over the holiday and published ASAP, this is an audio-only episode with limited show notes.
We discuss:
Comparing omicron to delta and other variants [4:15];
Measuring immunity and protection from severe disease—circulating antibodies, B cells, and T cells [13:15];
Policy questions: what is the end game and how does the world go back to 2019? [18:45];
A policy-minded framework for viewing COVID and the problem of groupthink [24:00];
The difference between science and advocacy [39:00];
Natural immunity from COVID after infection [46:00];
The unfortunate erosion of trust in science despite impressive progress [57:15];
Do the current mandates and policies make sense in light of existing data? [1:02:30];
Risks associated with vaccines, and the risk of being labeled an anti-vaxxer when questioning them [1:18:15];
Data on incidence of myocarditis after vaccination with the Pfizer and Moderna vaccines [1:26:15];
Outstanding questions about myocarditis as a side effect of mRNA vaccination and the benefit of boosters [1:35:00];
The risk-reward of boosters and recommendations being ignored by policy makers in the US [1:40:30];
Sowing distrust: lack of honesty and humility from top officials and policy makers [1:43:30];
Thoughts on testing: does it make sense to push widespread testing for COVID? [1:52:15];
What is the endpoint to all of this? [1:58:45];
Downstream consequences of lockdowns and draconian policy measures [2:05:30];
The polarized nature of COVID—tribalism, skeptics, and demonization of ideas [2:10:30];
Looking back at past pandemics for perspective and the potential for another pandemic in the future [2:20:00];
What parents can do if their kids are subject to unreasonable policies [2:25:00];
Voices of reason in this space [2:28:45];
Strong convictions, loosely held: the value in questioning your own beliefs [2:32:15];
In this special episode, Peter addresses the common questions about starting or returning to an exercise routine over the age of 50. Individuals in this age group have frequently reached out with questions about whether it's too late to start exercising and often express concern over a lack of prior training, a fear of injury, or uncertainty about where to begin. Peter delves into the importance of fitness for older adults, examining all four pillars of exercise, and provides practical advice on how to start exercising safely, minimize injury risk, and maximize potential benefits. Although this conversation focuses on people in the “older” age category, it also applies to anyone of any age who is deconditioned and looking to ease into regular exercise.
We discuss:
Key points about starting exercise as an older adult [2:45];
Why it’s never too late to begin exercising and incorporating the four pillars of exercise [5:45];
The gradual, then sharp, decline in muscle mass and activity level that occur with age [10:00];
The decline of VO2 max that occurs with age [15:30];
Starting a training program: exercise variability, movement quality, realistic goals, and more [18:30];
Improving aerobic capacity: the malleability of the system, the importance of consistency, and setting long-term fitness goals [25:15];
Starting cardio training: base building, starting with low volume, and zone 2 training [30:45];
The critical role of VO2 max in longevity [36:45];
How to introduce VO2 max training to older or deconditioned individuals [46:15];
Options for performing zone 2 and VO2 max training [53:45];
The ability to make gains in strength and muscle mass as we age [57:00];
How to implement strength training for older individuals [1:01:00];
Advice for avoiding injury when strength training [1:07:30];
Risk of falls: the devastating consequences and the factors that increase fall risk [1:12:15];
Mitigating fall risk: the importance of foot and lower leg strength, ankle mobility, and balance [1:19:45];
Improving bone mineral density through resistance training [1:24:30];
The importance of protein in stimulating muscle protein synthesis, especially in older adults [1:31:00];
#180 - AMA #28: All things testosterone and testosterone replacement therapy
00:20:37
In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss all things related to testosterone: what happens when testosterone levels are low, and the potential benefits and risks of testosterone replacement therapy (TRT). They explain the physiology of testosterone, how it works, and how its level changes over the course of a person's life. They have a detailed discussion about existing literature, which reveals vast potential structural, functional, and metabolic benefits of testosterone replacement therapy. They also take a very close look at potential risks of this therapy, with a focus on the controversial effects on cardiovascular disease and prostate cancer.
If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #28 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
We discuss:
A primer on the hormone testosterone and how it influences gene expression [3:30];
How the body naturally regulates testosterone levels [11:30];
The defining threshold for "low testosterone," how low T impacts men, and why free testosterone is the most important metric [16:15];
When it makes sense to treat low testosterone [26:00];
The structural and metabolic benefits of testosterone replacement therapy [29:15];
Body composition changes with TRT [45:30];
Changes in bone mineral density with TRT [48:15];
The metabolic impact of TRT: glucose, insulin, triglycerides, and more [52:30];
A study investigating testosterone replacement therapy for prevention or reversal of type 2 diabetes [59:30];
The impact of TRT on metabolic parameters and body composition—A study comparing results from continuous vs. interrupted treatment [1:07:15]
The controversy over TRT and cardiovascular disease [1:21:45];
Two flawed studies that shaped perceptions of risks associated with TRT [1:44:15];
The controversy over TRT and prostate cancer [1:56:45];
Other potential risks with testosterone replacement therapy [2:02:15]; and
#177 - Steven Rosenberg, M.D., Ph.D.: The development of cancer immunotherapy and its promise for treating advanced cancers
02:06:26
Steve Rosenberg is the Chief of Surgery at the National Cancer Institute, a position he has held continuously for the past 47 years. Steve is a pioneer in the field of immunotherapies for cancer and a recipient of nearly every major award in science. In this episode, Steve discusses his inspiration for devoting his career to cancer research and describes his keen observation of two cases of spontaneous cancer remission, driving him to learn how to harness the immune system to treat cancer. Steve’s personal story essentially serves as a roadmap for the field of immunotherapy, from the very non-specific therapies such as interleukin-2, the discovery of tumor-infiltrating lymphocytes, checkpoint inhibitors, CAR T-cells, and adoptive cell therapy. Perhaps most importantly, Steve expresses his optimism for what lies ahead, especially in the face of some of the more recent discoveries with respect to tumor antigenicity. Finally, Steve discusses the human side of cancer which helps him to never lose sight of why he chose to become a physician.
We discuss:
Steve’s childhood and inspiration to become a physician and medical researcher [3:15];
Patients that influenced Steve’s thinking about cancer and altered the course of his career [13:15];
The discovery of antigen presentation, Steve’s first job, and why he knew he wanted to study cancer [19:30];
Cancer treatment in the early 1970’s and Steve’s intuition to utilize lymphocytes [26:45];
Cancer cells versus non-cancer cells, and why metastatic cancer is so deadly [31:45];
The problem with chemotherapy and promise of immunotherapy [38:30];
How the immune system works and why it seems to allow cancer to proliferate [43:15];
Steve discovers how to use interleukin-2 to mediate cancer regression [52:00];
The immunogenic nature of certain cancers and the role of mutations in cancer [1:03:45];
The improbable story of how CAR T cell therapy was developed [1:16:30];
The discovery of tumor infiltrating lymphocytes (TIL) and engineering of T cells to recognize specific antigens [1:28:00];
Steve’s experience treating President Ronald Reagan’s colon cancer [1:36:00];
Why Steve has turned down many tempting job offers to focus on his research at the National Cancer Institute [1:41:00];
The role of checkpoint inhibitors in cancer therapy and the promise of adoptive cell therapy [1:43:00];
Optimism for using immunotherapy to cure all cancers [1:48:00];
The human side of cancer and the important lessons Peter learned from working with Steve [1:52:15]; and
Andrew Huberman is a Professor of Neurobiology at Stanford University and host of the Huberman Lab podcast. In this episode, Andrew begins with a fascinating discussion about the brain, including the role of the prefrontal cortex in adjusting your ruleset to match your setting, the neural circuitry underlying the ability of stress to limit creativity and problem-solving, the effect of belief on physiology and performance, and more. He speaks about vision being our “superpower” and compares this to animals that rely more on other senses. Next, he opens up about his personal journey, the struggles and losses he has overcome, the value of therapy, and the many great people who helped him along the way. He speaks to his love of biology and discovery and the importance of staying true to your passion rather than being driven purely by ambition. Lastly, the conversation includes a look to the future of Andrew's scientific work and podcast as well as his unique approach to communicating science and tackling the issue of scientific illiteracy.
We discuss:
Exercise under blood flow restriction, lactate utilization, and transient changes in the brain function in response to adrenaline and stress [3:30];
The role of the prefrontal cortex in governing rulesets [9:15];
New discoveries about the circuitry between the prefrontal cortex, insula, and amygdala, and the insights gleaned about brain function in different emotional states [15:30];
Comparing human vision and other senses to animals [26:00];
A deep dive into vision: evolutionary adaptations, facial recognition, color, and more [39:45];
Sense of smell, pheromones, and why evolution developed better vision over smell [46:30];
The relationship between visual input and time perception [55:30];
Mindset effects: the effect of belief on physiology and performance [1:00:45];
Accessing higher levels of creativity with broadening rulesets and the limiting nature of stress and fear on creativity [1:05:30];
Stress and fear increase autonomic arousal, limit access to rulesets, and inhibit performance [1:12:15];
Andrew’s upbringing, early childhood, and tough adolescent years [1:15:00];
Andrew’s time in a residential treatment program and how he benefited from therapy [1:20:15];
The beginning of positive changes in Andrew’s young life [1:28:30];
Andrew’s decision to turn his life around [1:37:00];
A new passion for science and exercise helps Andrew [1:42:00];
The difference between a postdoc and a PhD [1:54:15];
Staying in touch with the love of biology and not getting pulled into ambition [1:59:15];
Andrew starts his own lab, and continues work to overcome his demons [2:07:00];
The loss of three mentors leads to deep soul searching [2:12:00];
What motivated Andrew to begin his podcast [2:18:00];
Looking to the future of Andrew’s scientific work, podcast, and more [2:22:45];
Andrew’s unique approach to communicating science and the issue of scientific illiteracy [2:30:00]; and
#291 ‒ The role of testosterone in males and females, performance-enhancing drugs, sustainable fat loss, supplements, and more | Derek, More Plates More Dates Pt.2
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
#105 - Paul Conti, M.D.: The psychological toll of a pandemic, and the societal problems it has highlighted
01:26:44
In this episode, psychiatrist Paul Conti, M.D. discusses the impact of the fear and uncertainty surrounding the COVID-19 pandemic and the resulting stress, anxiety, and trauma it may impart on the population. Paul examines how this situation has highlighted the challenges we face at the societal level as well as the individual level, and stresses the importance of seeking absolute truth above personal truth and taking action as individuals as a means to combat many of these pervasive problems.
We discuss:
Paul’s personal experience with a presumptive case of COVID-19 [2:15];
Through the lens of trauma, Paul’s overall take on the lasting effects of this pandemic on society [4:30];
The imperative to unite as a species given the isolating and suspicious nature of an invisible enemy [8:15];
The indigent population and the affluent population—The commonalities and differences in how both populations have been affected [16:15];
The prevailing feeling of demoralization spanning the population [25:30];
Health care workers—What lingering psychological effects might they suffer from this? [35:00];
Could this pandemic be a catalyst for changing the way people think about science, truth, and logic? [46:30];
How our inability to deal with uncertainty exacerbates the problem, and the need for humility [58:00];
What has been Paul’s recipe for self care during this time? [1:06:45];
The forthcoming challenge of reintegrating back into the world when the quarantines lift [1:14:45];
An urgent need for change which must come through individuals seeking absolute truth and taking action [1:19:15]; and
In this episode, Damon Hill, 1996 Formula 1 World Champion, opens up about his personal struggles with depression, feelings of inadequacy, loss of identity, and his ultimate path to healing following his remarkable racing career. Damon’s life was given a tragic jolt at 15 years of age when his father and legendary F1 driver Graham Hill died suddenly—the common string that ties together so much of his life and has forged so much of who he is to this day. We discuss Damon’s unique and remarkable racing career including his legendary battles with Michael Schumacher as well as Damon's firsthand account of what happened that tragic day on May 1st, 1994, when his teammate, Ayrton Senna, died at Imola. But this is not just about racing; rather it’s a human story that's cloaked in a racing one.
Sean Mackey is a professor of pain medicine at Stanford University and the director of the Stanford Systems Neuroscience and Pain Lab, where his research explores the neural mechanisms of pain and the development of novel treatments for chronic pain. In this episode, Sean joins Peter for a wide-ranging discussion on the multifaceted nature of pain—as both a sensory and emotional experience—and its evolutionary purpose as a critical survival mechanism. He dives into how pain is transmitted through the nervous system, the different types of pain, and why different individuals perceive pain so differently. Sean shares insights into pain management strategies ranging from medications like NSAIDs and opioids to neuromodulation techniques such as transcutaneous electrical nerve stimulation (TENS). Additionally, this episode explores the interplay between sleep and chronic pain and the psychological and emotional dimensions of pain, and it includes a personal story from Peter about his own experience with pain and how Sean’s expertise helped him more than two decades ago.
We discuss:
The definition of pain, and how our understanding of pain has evolved from a simplistic body-mind separation to a nuanced biopsychosocial model [2:30];
The biological mechanisms behind how we perceive pain [9:30];
The role of consciousness in the perception of pain, and how nociception functions during unconscious states [14:30];
The four types of pain [22:00];
Using fMRI to identify objective biomarkers of pain in the brain [31:30];
The evolutionary role of pain in human behavior and survival [36:00];
How the brain processes and modulates pain signals, Gate Control Theory, the variability in individuals’ pain perception, and effectiveness of neuromodulation techniques like TENS [41:00];
The brain’s influence on pain: the role of emotion, beliefs, sleep, and individual differences in perception and tolerance [53:45];
Peter’s personal journey with chronic back pain, and how the emotional consequences of pain can be more distressing than the pain itself [1:04:30];
The pharmacology of common pain medications—NSAIDs, COX-2 inhibitors, and acetaminophen [1:09:30];
Muscle relaxants: benefits, drawbacks, and personalized strategies [1:20:30];
The definition of chronic pain [1:29:15];
The role of antidepressants in pain management [1:30:15];
Opioids: their controversial and nuanced role in pain management [1:33:45];
Alternative therapies: acupuncture and cannabis [1:54:15];
Fibromyalgia and chronic pain: clinical features, brain mechanisms, and emerging treatments like low-dose naltrexone [2:01:00];
Possible brain benefits of low-dose naltrexone (LDN) for people with mild cognitive impairment [2:15:00];
Peter’s recovery from severe chronic pain—how he went from immobility and high-dose opioids to full functionality [2:20:15];
Breaking the pain cycle: how physical rehabilitation and psychological recovery work together in chronic pain treatment [2:30:45];
Sean’s struggle with cluster headaches, and the value of knowledge, preparation, and empathy in both managing chronic pain and caring for patients [2:39:15]; and
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
Siddhartha Mukherjee is an oncologist, Pulitzer Prize-winning author, and previous guest on The Drive. In this episode, Sid discusses many of the subjects of his latest book, The Song of the Cell, including the incredible discovery of the cell and how it transformed medicine. He explains the evolutionary drive to go from single-cell to multicellular life and unpacks the four different types of cell-based therapies and the problems they are attempting to solve. He also provides the latest in gene therapy, such as CRISPR, and the ethical questions around human gene editing. Additionally, he touches on a number of fascinating topics, such as the challenges of medical science, the human brain, learning styles, his writing process, mental health, and more.
We discuss:
How the cell brings the genome to life, and how Sid’s recent book fits into his prior work to tell a story [2:30];
How the germ theory of disease and an understanding of the cell fueled a big leap in medicine [9:45];
What is the evolutionary drive for multicellular life? [17:15];
Four types of cell therapies and the challenges of gene therapy [26:00];
CAR T-cell therapy: promising gene therapy for cancer [36:30];
The possibility of using gene therapy to treat germline mutations like sickle cell disease [41:45];
The incredible revolution of gene editing with CRISPR [45:15];
Ethical questions around human gene editing [52:30];
The complex role of genetics in mental illness [1:01:30];
Two types of problems in science: the “eye in the sandstorm” problem and the “sand in the eye” problem [1:06:15];
Understanding neural networks: an example of the “sand in the eye” problem being solved [1:08:45];
Importance of learning by doing: comparing the learning styles of a doctoral student to a medical student [1:16:30];
Sid’s unique and brilliant style of writing [1:20:45];
Falling as the leading cause of accidental death: a liability of multicellular existence [1:25:00];
Sid’s struggle with depression and his desire to change the stigma around mental illness [1:29:15]; and
Mike Joyner is a physician-researcher and one of the world’s leading experts on human performance and exercise physiology. In this episode, Mike discusses how to combat age-related declines in health and fitness levels by using various modes of exercise to improve lifespan and healthspan. Mike explains the impact of exercise on the autonomic nervous system, blood pressure, heart rate, heart rate variability, heart rate recovery, and max heart rate. He dives deep into VO2 max, including how it’s measured, what is driving it, and how to improve it. Mike provides training insights for the average person, including training volume and exercise intensity as well as simple metrics to track. Furthermore, he gives his take on the theoretical “J-curve” relationship between exercise and longevity, as well as whether possible health dangers may be associated with excessive exercise.
We discuss:
Mike’s training as an anesthesiologist and interest in exercise physiology [2:30];
How exercise increases longevity [7:00];
The impressive data on the benefits of exercise [9:45];
The Centenarian Olympics and other ways to mitigate age-related decline in strength and stability [15:00];
The violent dropoff in strength and activity with age and how exercise preserves fitness in old age [19:00];
Benefits of exercise on mortality and fracture risk, and the interplay of nutrition and exercise [22:00];
How exercise benefits the autonomic nervous system and why this plays an important role in our health [26:30];
VO2 max, heart rate recovery, heart rate variability, and other metrics of fitness positively impacted by exercise [28:30];
Reduction in all-cause mortality with increased fitness levels and VO2 max [32:45];
Does the relationship between exercise and longevity follow a J-curve? [40:00];
Mitigating age-related decline in fitness by elevating your VO2 max at a young age [46:15];
Breaking down the variables that drive VO2 max [54:30];
Learning from elite athletes: Training regimens, aerobic efficiency, and other impressive metrics [1:00:15];
Health benefits of light exercise for the average person [1:09:00];
Simple training metrics to track, and Mike’s current exercise regimen [1:11:15];
How to boost your VO2 max, and the importance of form and tempo with interval training [1:18:15];
Training advice for the average person [1:25:15];
Why professional athletes have longer careers than they’ve had in the past [1:27:30];
Use of performance-enhancing drugs in professional sports [1:29:45];
Can the miracle of exercise be put in a pill? [1:36:00];
Mike’s current research and questions he’s most interested in answering [1:39:00];
Use of convalescent plasma to treat COVID-19 [1:41:15];
Parting thoughts on the current state of fitness and exercise in society [1:47:15];
Michael Easter is the author of the bestseller, The Comfort Crisis. He’s also a journalist, Professor of Journalism at UNLV, and a leading voice on how humans can integrate modern science and evolutionary wisdom for improved health, meaning, and performance in life and at work. In this episode, Michael first talks about his upbringing, including his parents' struggle with alcoholism, his father leaving when he was young, and how these things impacted Michael's own struggle with alcoholism. He explains what led to his realization that we are in a “crisis of comfort” and how the removal of many of life’s discomforts through advancements in modern society may actually be a leading contributor to many of our most urgent physical and mental health issues. He explains the benefits of challenging oneself and the immense positive carryover which can come from doing things we find difficult. He describes the consequences of technology like smartphones, which have effectively eliminated boredom—a discomfort that comes with many benefits. He tells the story of a profound experience at an elk hunt that changed Michael’s thoughts around life and death, how happiness can thrive in places without all of the modern comforts of the West, and why we’re hardwired for stress and what to do about it. They conclude with a conversation around rucking, an activity with many physical and mental benefits.
We discuss:
The value in doing something difficult [2:30];
Michael’s upbringing with a single parent and alcoholism [5:45];
Michael’s battle with alcoholism and his experience with quitting drinking [10:00];
Origin of the idea that we are in a crisis of comfort [20:30];
The death of boredom in modern society [28:45];
The benefits of boredom [36:00];
The value of disconnecting and being in nature [39:15];
Changing the dynamic of how we think about food and the story of Peter’s daughter’s first hunt [43:45];
How a profound experience at an elk hunt changed Michael’s thoughts about life and death [49:15];
How happiness can thrive in places without all of the modern comforts of the West [57:15];
Why we’re hardwired for stress, and the responsibility that comes with our level of comfort [1:05:30];
How perspective on the timescale of our lives in relation to history can impart positive changes [1:14:00];
The benefit of challenging oneself and the positive carryover it can have [1:19:45];
The many benefits of rucking [1:28:45];
Tips for rucking: ideal load, type of pack, and other considerations [1:38:00];
Parting thoughts on the downside of comfort and benefits of difficult things [1:43:00]; and
#96 - David Epstein: How a range of experience leads to better performance in a highly specialized world
02:37:10
In this episode, David Epstein, best-selling author of Range and The Sports Gene, discusses the evidence around the most effective ways to improve long-term performance and learning in our specialties, our sports, our careers, and our lives. David makes a compelling case that a range of experiences and skills are more likely to lead to expert performance compared to early specialization, and offers an in-depth critique of the much-publicized 10,000-Hour Rule. David also provides insights into our role as parents in the process of encouraging exposure to many things, the concepts of when to push them, when to give them space, and when to allow them to quit. Furthermore, David goes into many other fascinating topics such as the role of talent, genetics, and practice in reaching expert status, what differentiates a kind vs. wicked learning environment, the importance of “informal training,” and many case studies that suggest strategies for short-term success may not be best for long-term development.
We discuss:
A shared interest in Ayrton Senna, and pondering the value in participating in sports [2:30];
Examining the 10,000-Hour Rule, and the importance of questioning existing dogma [15:00];
How the medical profession is affected by bad science, and the importance of understanding individual variation [28:00];
David’s most surprising findings when writing The Sports Gene [35:45];
Kind versus wicked learning environments [40:45];
How and why strategies for short-term success may not be best for long-term development [47:30];
Contrasting the success stories of Tiger Woods and Roger Federer—which path is more common, and an argument for diversified training and experiences [59:15];
Is there an age-range or “critical window” during which exposure is necessary to reach a certain level of proficiency or mastery of a skill or knowledge? [1:14:00];
How diversifying your interests and unraveling your identity from your speciality could lead to more enjoyment and actually improve performance in your speciality [1:22:15];
The undervalued importance of “informal training” [1:29:15];
Advice for increasing match quality in your work—where interests and abilities align—to optimize both job performance and fulfillment [1:41:15];
Would David want his own son to attend college given the current state of higher education? [1:51:15];
The role of a parent—how to encourage sampling, when to push them, when to allow them to quit, and insights from the childhoods of Tiger Woods and Wolfgang Mozart [1:55:45];
The need for varied perspectives and the ability to improvise—insights gained from the Space Shuttle Challenger tragedy [2:08:45];
How a diversified background and identity could be the difference in life or death—the Hotshot firefighters case study [2:22:15];
David’s takeaways from the inspiring story of Frances Hesselbein [2:29:00]; and
#137 - Paul Offit, M.D.: An expert perspective on COVID-19 vaccines
01:35:57
Paul Offit is a pediatrician specializing in infectious diseases and an expert in virology and vaccine development. He currently serves on the FDA committee overseeing and evaluating COVID-19 vaccines. In this episode, Paul discusses the strategies and major companies pursuing a vaccine against the SARS-CoV-2 virus. He gets into the nuances of the vaccine approval process and its implications for COVID-19 vaccine outlook. Paul also explains potential risks, reveals his own confidence level in safety, and gives insight into protection against reinfection with vaccination. Please note that this episode was recorded 11/05/2020, prior to the 11/09/2020 news release of the Pfizer vaccine update.
We discuss:
How Paul’s experience as a child in a chronic care hospital as child informed his path in pediatrics and vaccine development (3:30);
Addressing the anti-vaccination sentiment and explaining the fraudulent origins of the anti-vaccination movement (8:00);
Lessons and insights from 26 years studying rotavirus and creating a successful rotavirus vaccine (17:00);
Developing a new vaccine: the different phases of clinical trials, overall timeline, and financial costs (27:15);
Operation Warp Speed: the expedited process of creating a coronavirus vaccine (32:30);
Various vaccine strategies—RNA, DNA, virus vector—and the challenges associated (35:00);
The Moderna and Pfizer mRNA vaccines: strategy, timeline, and Emergency Use Authorization (41:15);
Paul’s confidence level in the safety of the first coronavirus vaccines (48:30);
The risks associated with different types of vaccines, and updates on the Johnson & Johnson and Astrazeneca coronavirus vaccines (52:15);
What we know about the coronavirus vaccines approved in Russia and China (55:45);
The latest on the Merck coronavirus vaccine (57:15);
The recombinant/purified protein vaccine approach for coronavirus—big players, risks, and the best vaccine for the elderly (57:45);
Attenuated and inactivated vaccine strategies for coronavirus (1:02:00);
The genetic drift of SARS-CoV-2: Impacts for protection and vaccine development (1:02:30);
Paul’s take on the hypothesis that a previous coronavirus infection offers protection against the novel COVID-19 (1:06:45);
Addressing the concern that antibodies fade over time (1:09:15);
Blood type and protective against coronavirus (1:13:00);
Distribution: the challenge of prioritizing the limited doses of vaccines after approval (1:13:15);
Paul’s perspective on COVID-19 vaccine safety (1:16:15);
Considerations regarding vaccinating children for coronavirus and the role of a fever immune response (1:21:45);
Why vaccine development can be challenging and risks of current COVID-19 strategies (1:29:45); and
The Qualysis a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed.Qualysis short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day.The Qualysare short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed onThe Drive.
Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.
Don Layman is a Professor of Food Science and Human Nutrition at the University of Illinois Urbana-Champaign. He has spent the past 40 years investigating the role of dietary protein in muscle protein synthesis. In this episode, Don describes how his decades of research have shaped his thinking around protein, muscle, anabolic factors, metabolism, and more. He explains the recommended dietary allowance (RDA) for protein: what it is, how it came about, and how it should serve only as a guide for the minimum protein necessary for survival rather than as an optimal level of protein intake. He provides an overview of the essential amino acids, explains the nuances of animal versus plant protein, and provides insights for determining protein quality, absorption rates, and how to best track your intake. He discusses the ideal timing of protein intake in relation to resistance exercise, how protein should be distributed among meals, and how limitations in protein utilization per sitting can impact those practicing time-restricted eating. Additionally, Don shares results from his clinical trials, including how a high-protein diet fared in terms of fat loss, and explains the differences in protein utilization between adolescents and adults and how the problem of reduced efficiency of protein utilization in older adults can be overcome.
We discuss:
Don’s background: from growing up on a farm to studying nutritional biochemistry [2:30];
Don’s philosophy on nutrition, muscle, and metabolism [6:30];
The controversial relationship between saturated fat and atherosclerosis [18:15];
The basics of protein and amino acids [25:45];
Origin and limitations of the current recommended dietary allowance (RDA) for protein intake [32:15];
Protein sources: determining quality, absorption rates, and how to track intake [41:15];
Leucine, lysine, and methionine: three important essential amino acids [48:00];
The vital role of ruminant animals in the production of quality protein [53:15];
The differing needs and impacts of dietary protein for a 16-year old compared to a 65-year old [59:30];
Consequences of protein deficiency in childhood [1:06:30];
Muscle protein synthesis: ideal timing, small meals vs. big meals, and more [1:12:45];
Protein needs of children [1:19:45];
How important is timing protein intake around training? [1:24:15];
The role of leucine in fatty acid oxidation by muscle [1:28:15];
High protein diets for fat loss: Results from Don’s clinical trials [1:31:30];
Influence of industry funding on nutrition studies [1:43:45];
Don’s thoughts on plant-based and synthetic “meats” [1:48:45];
Problems with epidemiological studies of dietary protein [1:56:30];
#84 - AMA #10: Low testosterone, hypothyroidism, building muscle (and preserving it while fasting)
00:10:33
In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter’s head of research, asks the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA.
If you’re a subscriber, you can now listen to this full episode on your private RSS feed. You can also listen to this full episode on our website at the AMA #10show notes page.
We discuss:
Does testosterone supplementation impact longevity? [2:40];
Under what conditions does Peter decide to treat patients who have low testosterone? [8:50];
Are there risks involved with testosterone replacement therapy? [17:10];
How does Peter diagnose and treat hypothyroidism? [21:30];
How might someone do time-restricted feeding while also adding muscle mass? [26:30];
If building muscle requires higher levels of IGF-1, should we be concerned about longevity? [34:45];
How to preserve muscle mass while fasting [41:45];
Is it possible to simultaneously lose fat and add muscle mass? [46:30]; and
#155 - Chris Sonnenday, M.D.: The history, challenges, and gift of organ transplantation
02:14:33
Chris Sonnenday is the Transplant Center Director for Michigan Medicine. As Peter’s senior resident while at Johns Hopkins, Chris made a lasting impression on him with his remarkable leadership and ability to maintain his humanity through the stressors of that challenging environment. In this episode, Chris tells the incredible backstory of the history of transplant medicine, focusing on the kidney and the liver. He discusses the surgical and immunologic developments that launched the field forward, but also lays out the challenges ahead for the field, such as the rising prevalence of chronic kidney and liver failure. Chris also tells many stories of tragedy and triumph that comes with working in organ transplantation, but ultimately explains the rewarding nature of being a witness to the gift of organ donation.
We discuss:
What attracted Chris to medicine, and his leadership in residency (3:30);
How Chris maintained his empathy and humanity through the stresses of med school and residency (8:30);
Why Chris chose a complicated field like transplant medicine (23:15);
Explaining kidney transplantation to showcase the challenge of organ transplantation surgery (28:00);
Overcoming the immune-based challenges of transplant surgery (37:00);
How the discovery of cyclosporine transformed the field of organ transplantation (49:00);
Rising chronic kidney failure due to the prevalence of pre-diabetes and metabolic syndrome (53:45);
Why living kidney donations are superior, and the possibility of a market for kidney donation (59:30);
Designing a fair system of organ distribution (1:17:30);
The debate on what constitutes “death” when deciding when to take organs from a registered organ donor (1:21:45);
Reflections on the gift of organ donation (1:33:15);
The history of liver transplantation and why it’s so complex (1:39:15);
Addressing acute liver failure and the amazing baboon experiment (1:46:15);
The potential for the rising prevalence of NAFLD and NASH to overwhelm the liver transplant infrastructure in the US (1:54:45);
The importance of teamwork in successful organ transplantations, and the most tragic event Chris has ever witnessed (2:05:45); and
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
Zone 2 training: impact on longevity and mitochondrial function, how to dose frequency and duration, and more | Iñigo San-Millán, Ph.D. (#201 rebroadcast)
Iñigo San-Millán is an internationally renowned applied physiologist and a previous guest on The Drive. His research and clinical work focuses on exercise-related metabolism, metabolic health, diabetes, cancer metabolism, nutrition, sports performance, and critical care. In this episode, Iñigo describes how his work with Tour de France winner Tadej Pogačar has provided insights into the amazing potential of elite athletes from a performance and metabolic perspective. He speaks specifically about lactate levels, fat oxidation, how carbohydrates in food can affect our lactate and how equal lactate outputs between an athlete and a metabolically unhealthy individual can mean different things. Next, he discusses how Zone 2 training boosts mitochondrial function and impacts longevity. He explains the different metrics for assessing one’s Zone 2 threshold and describes the optimal dose, frequency, duration, and type of exercise for Zone 2. Additionally, he offers his thoughts on how to incorporate high intensity training (Zone 5) to optimize health, as well as the potential of metformin and NAD to boost mitochondrial health. Finally, he discusses insights he’s gathered from studying the mitochondria of long COVID patients in the ICU.
We discuss:
The amazing potential of cyclist Tadej Pogačar [2:00];
Metrics for assessing athletic performance in cyclists and how that impacts race strategy [7:30];
The impact of performance-enhancing drugs and the potential for transparency into athletes’ data during competition [16:15];
Tadej Pogačar’s race strategy and mindset at the Tour de France [23:15];
Defining Zone 2, fat oxidation, and how they are measured [26:00];
Using fat and carbohydrate utilization to calculate the mitochondrial function and metabolic flexibility [35:00];
Lactate levels and fat oxidation as it relates to Zone 2 exercise [39:15];
How moderately active individuals should train to improve metabolic function and maximize mitochondrial performance [51:00];
Bioenergetics of the cell and what is different in elite athletes [56:30];
How the level of carbohydrate in the diet and ketogenic diets affects fuel utilization and power output during exercise [1:07:45];
Glutamine as a source for making glycogen—insights from studying the altered metabolism of ICU patients [1:14:15];
How exercise mobilizes glucose transporters—an important factor in diabetic patients [1:20:15];
Metrics for finding Zone 2 threshold—lactate, heart rate, and more [1:24:00];
Optimal Zone 2 training: dose, frequency, duration, and type of exercise [1:40:30];
How to incorporate high intensity training (Zone 5) to increase VO2 max and optimize fitness [1:50:30];
Compounding benefits of Zone 2 exercise and how we can improve metabolic health into old age [2:01:00];
The effects of metformin, NAD, and supplements on mitochondrial function [2:04:30];
The role of lactate and exercise in cancer [2:12:45];
How assessing metabolic parameters in long COVID patients provides insights into this disease [2:18:30];
The advantages of using cellular surrogates of metabolism instead of VO2 max for prescribing exercise [2:25:00];
Metabolomics reveals how cellular metabolism is altered in sedentary individuals [2:33:00];
Cellular changes in the metabolism of people with diabetes and metabolic syndrome [2:38:30]; and
#253 ‒ Hormone replacement therapy and the Women’s Health Initiative: re-examining the results, the link to breast cancer, and weighing the risk vs reward of HRT | JoAnn Manson, M.D.
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
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