The Peter Attia Drive

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this episode of The Drive, Peter welcomes guests David Sabatini and Matt Kaeberlein, two world-leading experts on rapamycin and mTOR. David and Matt begin by telling the fascinating story of the discovery of rapamycin and its brief history as a pharmacological agent in humans. They then unravel the function of mTOR, a central regulator of numerous biological processes, and they discuss the pathways through which rapamycin exerts its potential benefits on lifespan. They touch upon initial studies that suggested rapamycin may have geroprotective effects and the ongoing research that continues to shed light on this unique molecule. Furthermore, they discuss the elusive details surrounding the frequency and dosing of rapamycin use in humans, and Peter emphasizes his reservations about indiscriminately prescribing rapamycin as a longevity drug for patients. We discuss: David and Matt's expertise in mTOR and rapamycin [3:00]; The discovery of rapamycin and its first use in humans as an immunosuppressant [13:15]; The emergence of rapamycin as a molecule with the potential to prolong lifespan [19:30]; The groundbreaking rapamycin study on mouse lifespan extension and the open questions about the timing and frequency of dosing [26:00]; Explaining mTOR and the biology behind rapamycin's effects [35:30]; Differences in how rapamycin inhibits mTOR complex 1 (MTORC1) versus mTOR complex 2 (MTORC2) [45:15]; Reconciling the biochemical mechanism of rapamycin with its longevity benefit [49:15]; Important discoveries about the interplay of amino acids (leucine in particular) and mTOR [54:15]; Reconciling rapamycin-mediated mTOR inhibition with mTOR's significance in building and maintaining muscle [1:01:30]; Unanswered questions around the tissue specificity of rapamycin [1:08:30]; What we know about rapamycin's ability to cross the blood-brain barrier and its potential impacts on brain health and neurodegeneration [1:13:45]; Rapamycin may act as an immune modulator in addition to immunosuppressive effects [1:21:30]; Might rapamycin induce changes in T cell methylation patterns, potentially reversing biological aging? [1:34:15]; Rapamycin side effects and impacts on mental health: fascinating results of Matt's survey on off-label rapamycin use [1:42:00]; The impact of taking rapamycin in people who contracted COVID-19: more insights from Matt's survey [1:51:15]; What David would like to study with mTOR inhibitors [1:54:45]; Joan Mannick's studies of RTB101 and other ATP-competitive inhibitors of mTOR [2:00:30]; The impact of mTOR inhibition on autophagy and inflammation and a discussion of biomarkers [2:10:00]; The Dog Aging Project: what we've learned and what's to come from testing rapamycin in companion dogs [2:17:30]; Preliminary results of primate studies with rapamycin [2:24:45]; Dosing of rapamycin [2:27:45]; The effect of rapamycin on fertility [2:36:45]; The outlook for future research of rapamycin and the development of rapalogs [2:39:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter dives deep into the critical topic of metabolic disease. He first sheds light on how poor metabolic health drives up the risk of developing other chronic diseases such as cardiovascular disease, cancer, neurodegenerative disease, and overall mortality. He explores the array of metrics and tests used to assess metabolic health, underscoring his preferred methodologies utilized with patients. Finally, Peter provides an overview of the factors one can manipulate in order to improve metabolic health. If you're not a subscriber and are listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #51 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Importance of metabolic health and a primer on metabolic disease [1:30]; How poor metabolic health increases one's risk for other chronic diseases [6:00]; How useful is body weight and BMI for estimating metabolic health? [9:45]; Overview of various tests and metrics used to understand metabolic health [12:15]; Traditional biomarkers and how Peter's point of view may differ from the guidelines [15:00]; Lactate: insights into metabolic health through fasting and resting lactate levels [17:00]; Zone 2 output: an important functional test of metabolic health [20:00]; Cardiopulmonary exercise testing (CPET) [25:45]; Visceral adipose tissue (VAT): what is VAT and how does it impact health? [27:00]; Oral glucose tolerance test (OGTT): how it works and why it is such an important metric for assessing metabolic health [32:15]; The utility of a continuous glucose monitor (CGM) [40:45]; Liver function and NAFLD [42:15]; Sleep as an intervention [46:00]; Exercise as an intervention [53:15]; Diet and nutrition [59:00]; How reducing stress can improve metabolic health [1:05:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Andrew Huberman, Professor of Neurobiology at Stanford University and host of the Huberman Lab podcast joins us in a special journal club episode. Peter and Andrew each present a recent paper that sparked their interests, delving into the findings, dissecting their significance, discussing potential confounders and limitations, and exploring remaining questions. Importantly, they share their methodologies for comprehending research studies, providing valuable insights for listeners to navigate this process independently. Peter presents an epidemiological study reevaluating a noteworthy metformin result that intrigued the anti-aging community, leading to discussions on metformin's geroprotective potential (or lack thereof) and the current lack of aging biomarkers. Andrew introduces a paper examining how our beliefs about the medications we take influence their biological effects, distinguishing the "belief effect" from a placebo effect and highlighting its exciting implications for the future. We discuss: The motivation behind this journal club conversation [2:45]; Why Peter chose a paper on metformin, how metformin works, and why it generated excitement as a longevity-enhancing agent [9:00]; Defining insulin resistance and its underlying causes [16:15]; Metformin as a first-line treatment for type 2 diabetes, and Peter's evolving interest in metformin as a geroprotective drug [22:00]; Defining the term “geroprotection” [24:45]; The 2014 study that got the anti-aging community interested in metformin [26:00]; Peter presents the 2022 paper that repeats the analytical approach from the 2014 Bannister study [33:15]; Greater mortality in the metformin group: how results differed between the 2022 paper and the 2014 paper [40:00]; Understanding statistical significance, statistical power, sample size, and why epidemiology uses enormous cohorts [51:45]; Interpreting the hazard ratios from the 2022 metformin study, and the notable takeaways from the study [56:45]; Drugs that may extend lifespan, why Peter stopped taking metformin, and a discussion of caloric restriction [1:08:45]; Current thoughts on the use of metformin for longevity [1:21:00]; Could there be any longevity benefit to short periods of caloric restriction? [1:22:45]; Peter and Andrew's process for reading scientific papers [1:26:45]; The biological effects of belief, and how “belief effects” differ from placebo effects [1:32:30]; The neurobiology of nicotine: a precursor conversation before delving into the paper Andrew chose [1:39:45]; Andrew presents a paper that demonstrates the impact of belief [1:45:30]; Analyzing the fascinating results of the Perl paper [1:54:30]; Exciting implications of the findings about “belief” reported by Perl and colleagues [2:03:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter This special episode is a rebroadcast of AMA #30, now made available to everyone, in which Peter and Bob Kaplan dive deep into all things related to studying studies to help one sift through the noise to find the signal. They define various types of studies, how a study progresses from idea to execution, and how to identify study strengths and limitations. They explain how clinical trials work, as well as biases and common pitfalls to watch out for. They dig into key factors that contribute to the rigor (or lack thereof) of an experiment, and they discuss how to measure effect size, differentiate relative risk from absolute risk, and what it really means when a study is statistically significant. Finally, Peter lays out his personal process when reading through scientific papers. We discuss: The ever-changing landscape of scientific literature [2:30]; The process for a study to progress from idea to design to execution [5:00]; Various types of studies and how they differ [8:00]; The different phases of clinical trials [19:45]; Observational studies and the potential for bias [27:00]; Experimental studies: randomization, blinding, and other factors that make or break a study [44:30]; Power, p-values, and statistical significance [56:45]; Measuring effect size: relative risk vs. absolute risk, hazard ratios, and “number needed to treat” [1:08:15]; How to interpret confidence intervals [1:18:00]; Why a study might be stopped before its completion [1:24:00]; Why only a fraction of studies are ever published and how to combat publication bias [1:32:00]; Frequency of training for Olympic weightlifting [1:22:15]; How post-activation potentiation (and the opposite) can improve power training and speed training [1:24:30]; The Strongman competition: more breadth of movement, strength, and stamina [1:32:00]; Why certain journals are more respected than others [1:41:00]; Peter's process when reading a scientific paper [1:44:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Wendy Chung is a board-certified clinical and molecular geneticist with more than 25 years of experience in human genetic disease research. In this episode, Wendy delves deep into the world of genetics by first exploring the historical landscape of genetics prior to decoding the human genome, contrasting it with what we know today thanks to whole genome and exome sequencing. She provides an overview of genetic testing by differentiating between various genetic tests such as direct-to-consumer, clinical, whole genome sequencing, and more. Additionally, Wendy unravels the genetic underpinnings of conditions such as PKU, breast cancer, obesity, autism, and cardiovascular disease. Finally, Wendy goes in depth on the current state and exciting potential of gene therapy while also contemplating the economic implications and ethical nature of gene editing. We discuss: Wendy's interest in genetics and work as a physician-scientist [2:45]; The genetics of phenylketonuria (PKU), a rare inherited disorder [5:15]; The evolution of genetic research: from DNA structure to whole genome sequencing [18:30]; Insights and surprises that came out of the Human Genome Project [28:30]; Overview of various types of genetic tests: direct-to-consumer, clinical, whole genome sequencing, and more [34:00]; Whole genome sequencing [39:30]; Germline mutations and the implications for older parents [45:15]; Whole exome sequencing and the importance of read depth [50:30]; Genetic testing for breast cancer [54:00]; What information does direct-to-consumer testing provide (from companies like 23andMe and Ancestry.com)? [1:01:30]; The GUARDIAN study and newborn genetic screening [1:06:30]; Treating genetic disease with gene therapy [1:18:00]; How gene therapy works, and the tragic story of Jesse Gelsinger [1:22:00]; Use cases for gene therapy, gene addition vs. gene editing, CRISPR, and more [1:28:00]; Two distinct gene editing strategies for addressing Tay-Sachs and fragile X syndrome [1:37:00]; Exploring obesity as a polygenic disease: heritability, epigenetics, and more [1:41:15]; The genetics of autism [1:48:45]; The genetics of cardiovascular disease [2:01:45]; The financial costs and economic considerations of gene therapy [2:06:15]; The ethics of gene editing [2:12:00]; The future of clinical genetics [2:21:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Keith Flaherty is the director of clinical research at the Massachusetts General Hospital Cancer Center and a previous guest on The Drive. In this episode, Keith first delves into the statistics on cancer's prevalence as we age, underscoring the significance of finding effective treatments and early detection methodologies. He touches on the history of cancer therapeutics and illuminates the notable enhancements in cancer therapy within the last decade that are setting the stage for a promising future. He goes into detail on the potential of immunotherapy and therapies that can combat cancer's evasive tactics while explaining some of the existing challenges around specificity, cost, and scalability. Additionally, Keith highlights the significant leap in early detection methodologies, namely liquid biopsies, which have the potential not only to determine if a cancer is present in an early stage, but also identify the possible tissue of origin. We discuss: Keith's interest and expertise in cancer [3:15]; Cancer deaths by decade of life, and how cancer compares to other top causes of death [7:00]; The relationship between hormones and cancer [12:00]; The link between obesity and cancer [18:45]; Current state of treatments for metastatic cancer and reasons for the lack of progress over the decades [22:30]; The interplay between the immune system and cancer cells [32:00]; Different ways cancer can suppress the immune response, and how immunotherapy can combat cancer's evasive tactics [39:30]; Elimination of a substantial portion of cancers through immune cell engineering faces challenges of specificity, cost, and scalability [52:15]; Why TIL therapy isn't always effective, and the necessity for multimodal therapy to address various aspects of the cancer microenvironment [1:01:00]; Potential developments in cancer therapy over the next five years: T-cell activation, metabolic interventions, targeting tumor microenvironments, and more [1:06:30]; The challenge of treating metastatic cancer underscores the importance of early detection to improve survivability [1:19:15]; Liquid biopsies for early detection of cancer and determining the possible tissue of origin [1:24:45]; Commercially available cancer screening tests [1:33:45]; How to address the disparity in cancer care, and the exciting pace of progress for cancer detection and treatment [1:40:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this "Ask Me Anything" (AMA) episode, Peter delves into the realm of genetics, unraveling its connection to disease and emphasizing the value of understanding one's genetic risks. He elucidates essential background knowledge on genetics before delving into the myriad reasons why individuals might consider genetic testing. Peter differentiates scenarios where genetic testing provides genuine insights from those where it may not be as useful. From there, Peter explores a comprehensive comparison of commercial direct-to-consumer genetic tests, providing insights on interpreting results and identifying the standout options for gaining insights into personal health. If you're not a subscriber and are listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #50 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Defining the term “genetics” and why it's important [2:15]; What is DNA, and how does it impact our biology and traits? [5:45]; How are genetics passed down from parent to child? [8:45]; How much do genes vary across individuals? [13:00]; Which traits are determined by genetics versus experience or environmental factors? [17:00]; Reasons for genetic testing [22:30]; What exactly is being measured by a genetic test? [29:15]; Testing for monogenic disorders [35:15]; Understanding polygenic risk [39:30]; Is genetic testing more important for someone who doesn't know their family history? [40:45]; What does it mean to be positive for a particular variant? [43:00]; What does it mean to be negative for a particular variant? [45:45]; How does someone get genetic testing through their healthcare provider, and how are these tests performed? [48:15]; The financial cost of various genetic tests [54:30]; Could having a risk allele for a disease result in an increase in one's insurance premium? [57:15]; Other risks associated with genetic testing [59:00]; How do commercial, direct-to-consumer genetic tests compare to the information one might receive from clinical genetic testing? [1:01:45]; Are certain direct-to-consumer tests better than others? [1:03:45]; How long until whole genome sequencing becomes genuinely useful? [1:16:00]; How useful are personalized dietary recommendations based on genetics? [1:18:15]; Final thoughts and advice regarding genetic testing [1:20:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Oliver Burkeman is the author of The New York Times best-seller Four Thousand Weeks: Time Management for Mortals. In this episode, Oliver delves into the pervasive idea that time can be mastered, exploring whether maximizing productivity is an attainable goal or a perpetual trap. He discusses the allure of attempting to control time—and, therefore, the future—and shares his personal journey of experimenting with diverse time management techniques that failed to deliver the emotional satisfaction he sought. Ultimately, they explore the mismatch between being a finite human and existing in a world of infinite possibilities and how all of these concepts intertwine with finding a sense of purpose and meaning. Additionally, Oliver shares insights from his book on productivity, using our time wisely, and embracing our finitude to live a more fulfilling life. We discuss: Oliver's experience that led him to write the book Four Thousand Weeks [3:15]; Human's relationship with time and the struggle with the finite nature of time [7:15]; How productivity can be a trap [11:00]; The fallacy that being more efficient will open up more time and bring a feeling of control [16:45]; The paradoxical nature of trying too hard to be present in the current moment [22:45]; The value of relationships in meaningful experiences and fulfillment, and how time gets its value from being shared [26:45]; The importance of time synchronicity [36:00]; Identifying your biggest priorities and the paradox of wanting to do more than you have time for [41:00]; Oliver's moment of clarity in 2014 [47:15]; The role of a sense of purpose in fulfillment [50:15]; Reconciling the finite nature of time and letting go of trying to master your time [59:00]; Why we tend to have a future-focused attitude and how to combat that with atelic activities [1:05:45]; The power of shifting your perspective about time and your experiences [1:12:45]; How to operationalize the three principles for the dilemma of finite time [1:20:15]; Harnessing the power of patience in the face of a problem or experience [1:28:00]; The value of incrementalism for being productive [1:34:15]; Embracing your finitude with curiosity [1:38:00]; Acting on an idea in the moment rather than letting the idea be the obstacle [1:41:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Adam Cohen is an orthopedic surgeon with expertise in sports medicine. In this episode, Adam breaks down the anatomy of the lower extremities: the hip, knee, ankle, and foot. He explains in detail the common injuries, sources of pain, and what leads to the development of arthritis. He lays out the non-surgical and surgical treatment options as well as the factors that determine whether surgery is appropriate. The discussion includes various procedures like hip replacement, knee replacement, ACL reconstruction, repair of meniscus tears, and more. Additionally, Adam sheds light on the utility of biological therapies like stem cells and platelet-rich plasma (PRP) and how they compare to more traditional approaches. We discuss: Anatomy of the hip, hip dysplasia in infants, and the development of arthritis [3:00]; Diagnosing hip pain in people under 50, stress fractures in the femoral neck, and more [11:15]; Common hip injuries, gender differences, and problems that occur when the hip isn't formed normally [19:30]; Advancements in hip replacement surgery [25:15]; Common hip problems in people over age 60 [27:30]; The importance of muscular strength around the hips for injury prevention [30:30]; Hip fractures due to osteopenia and osteoporosis [36:00]; The utility of biological therapies like stem cells and platelet-rich plasma (PRP) [40:30]; Cortisone as a treatment to delay the need for surgical intervention [53:30]; Anatomy of the knee [56:30]; Are activities like running that amplify forces bad for the knee? [59:45]; Risk of future knee issues and arthritis following an ACL tear or other substantial knee injury [1:04:30]; How the ACL injury happens and how it is repaired [1:08:30]; Arthritis of the knee [1:19:00]; Meniscus tears: how they happen and when surgery is appropriate [1:21:30]; Total knee replacement: when it's appropriate and how the recovery process compares to hip replacement [1:30:30]; Learning from elite athletes, heart rate recovery, V02 max, and other metrics [1:58:45]; Surgical vs. non-surgical approaches to various knee injuries [1:40:45]; Achilles tendon: tendinitis, rupture of the Achilles tendon, and prevention strategies [1:44:15]; Anatomy of the ankle and foot [1:49:00]; Common injuries to the ankle and foot [1:51:15]; Tips for finding a good orthopedic surgeon [2:01:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Michael “Micky” Collins is an internationally renowned expert in sports-related concussions and a consultant for multiple professional sports organizations. In this episode, Mickey first explains the definition and diagnosis of a concussion, as well as the diverse signs and symptoms associated with different types of concussions. He discusses the risk factors that contribute to increased susceptibility and/or severity of concussions in certain individuals, emphasizes the significance of prompt treatment, and uses case studies to illustrate the latest in treatment protocols and recovery process. Additionally, Mickey provides insight into the evolving field of concussion treatments, including the exploration of hyperbaric oxygen and synthetic ketones. He gives advice to parents of kids who play sports and discusses the promising prospects in the realm of concussion management. We discuss: Micky's interest in concussion and how he started the first concussion clinic [3:15]; Concussion: definition, pathophysiology, and risk factors making someone more susceptible [9:45]; Symptoms of concussion, predictors of severity, and the importance of early and effective treatment [20:00]; The six types of concussion, the effectiveness of treatment, and factors that impact recovery [25:45]; The importance of seeing a specialist and the prognosis for recovery [30:00]; Case study of a racecar driver who suffered a vestibular concussion [32:15]; Why vestibular concussions are particularly problematic [42:45]; A treatment plan for the racecar driver, possible use of medications, and how to address the root cause [45:45]; Exploring alternative treatments: hyperbaric oxygen, synthetic ketones, and more [52:00]; The natural history of a concussion if untreated and the effect, if any, of concussion on subsequent risk of brain disease [57:15]; Chronic traumatic encephalopathy (CTE) [1:01:45]; Advice for parents of kids who play sports: when and where to seek treatment for a possible concussion [1:04:45]; Is there any evidence that the APOE4 genotype increases susceptibility to concussion or TBI? [1:10:15]; The increased risk of concussions in older adults and a case study of a 90-year-old patient who suffered a head injury in a fall [1:11:15]; Funding for concussion research and fellowship programs to train concussion specialists [1:15:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this "Ask Me Anything" (AMA) episode, Peter goes into depth on the topic of brain health, starting with how Alzheimer's disease is diagnosed, the significance of blood-based biomarkers in diagnosis, and what the various APOE gene variants mean in terms of a person's risk of developing Alzheimer's disease. Next, Peter discusses the various strategies for preventing Alzheimer's disease and neurodegeneration. He touches briefly on exercise as a potent tool, but focuses more on lesser-known factors that could impact brain health, such as nutrition supplementation, lipid management, brain games, sauna, oral health, hearing loss, and more. If you're not a subscriber and are listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #49 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Topics: exercise, kidneys, and brain health [1:30]; Rucking: advice for beginners, proper load, packs, and shoes [4:30]; Rucking for women, bone health, using a treadmill, zone 2, and more [11:45]; Building vs. maintaining: when and how to transition from the goal of building muscle and strength to focusing on maintenance [16:00]; Should you lift weights before or after a cardio session? [24:00]; Heart rate recovery: defining heart rate recovery and how it relates to cardiovascular fitness [28:45]; How to measure heart rate recovery, and what is considered a "good" heart rate recovery [33:15]; How kidney health and function typically measured [42:30]; Differentiating between creatine and creatinine [48:15]; The cystatin C blood test as a practical way to assess kidney health [52:45]; How kidney function impacts lifespan and the five stages of kidney disease [59:15]; Slowing the decline of kidney function [1:08:15]; The main drivers of kidney disease [1:11:15]; The importance of managing homocysteine levels for brain health [1:14:00]; The relationship between alcohol consumption and brain health [1:21:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this special episode filmed live in front of readers of Outlive, Peter answers questions revolving around his concept of the centenarian decathlon. He starts by defining the “marginal decade” and how that shapes his training for the events and activities that make up his personal centenarian decathlon. Peter explains how he coaches patients through the challenges of customizing their own list and building out a training plan, including how to set fitness goals early in life in preparation for the marginal decade. From there, he dives into training within the four pillars (zone 2, VO2 max, stability, and strength), including the minimum effective dose, how to split your time, his personal protocols, and other considerations. Additionally, he touches on bone mineral density, female-specific considerations, working through injuries, and the profound impact training can have on the overall quality of life. We discuss: The best interventions for longevity [2:15]; The marginal decade and the centenarian decathlon [4:45]; Peter's personal list of events for his “centenarian decathlon” and how he helps patients create their own list [8:00]; Determining your fitness goals early in life in preparation for the marginal decade, metrics to track, and more [15:00]; How does playing sports like tennis, basketball, or golf fit into training for the centenarian decathlon? [24:15]; Training within the four pillars: minimum effect dose, how to split your time, and other considerations [27:45]; Advice for the older person and why it's never too late to start [33:45]; Bone mineral density and other female-specific concerns and considerations [36:15]; Training advice for those with minimal access to a gym or equipment [39:30]; Injuries: prevention and working through existing conditions [41:00]; Cardiorespiratory training: how to split time between zone 2 and VO2 max training, and different modalities for a true zone 2 workout [44:15]; VO2 max training: modalities, Peter's protocol, and how to monitor progress [54:45]; The profound impact training can have on the overall quality of life [58:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this special episode filmed live in front of readers of Outlive, Peter answers questions revolving around his concept of the centenarian decathlon. He starts by defining the “marginal decade” and how that shapes his training for the events and activities that make up his personal centenarian decathlon. Peter explains how he coaches patients through the challenges of customizing their own list and building out a training plan, including how to set fitness goals early in life in preparation for the marginal decade. From there, he dives into training within the four pillars (zone 2, VO2 max, stability, and strength), including the minimum effective dose, how to split your time, his personal protocols, and other considerations. Additionally, he touches on bone mineral density, female-specific considerations, working through injuries, and the profound impact training can have on the overall quality of life. We discuss: The best interventions for longevity [2:15]; The marginal decade and the centenarian decathlon [4:45]; Peter's personal list of events for his “centenarian decathlon” and how he helps patients create their own list [8:00]; Determining your fitness goals early in life in preparation for the marginal decade, metrics to track, and more [15:00]; How does playing sports like tennis, basketball, or golf fit into training for the centenarian decathlon? [24:15]; Training within the four pillars: minimum effect dose, how to split your time, and other considerations [27:45]; Advice for the older person and why it's never too late to start [33:45]; Bone mineral density and other female-specific concerns and considerations [36:15]; Training advice for those with minimal access to a gym or equipment [39:30]; Injuries: prevention and working through existing conditions [41:00]; Cardiorespiratory training: how to split time between zone 2 and VO2 max training, and different modalities for a true zone 2 workout [44:15]; VO2 max training: modalities, Peter's protocol, and how to monitor progress [54:45]; The profound impact training can have on the overall quality of life [58:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this episode, radiologist/engineer, Raj Attariwala, explains how he was able to apply his engineering background to create a unique MRI scanner that is capable of constructing whole-body images with a resolution that is unmatched in the industry. Peter and Raj discuss the implications of such a robust, radiation-free imaging tool on the early detection of cancer. They dive deep into cancer screening and define terms such as sensitivity and specificity that are necessary to really understand this complex space. They then describe the biggest risks involved in this type of screening (false positives) and how Raj's unique technology and process might drive down this risk substantially. But before that, they discuss all the common imaging technology from X-ray, to CT scan, to PET scans, to ultrasound, to MRI, and more. They touch on the history of each, how they work, the usefulness and limitations of each of them, as well as the varying risks involved such as radiation exposure. If you are interested in cancer screening and/or you've ever wondered how any radiology tool works, this episode is for you. We discuss: Raj's road from engineering to radiology [2:45]; How X-ray works, the risk of radiation exposure, and the varying amounts of radiation associated with the different imaging technologies [13:00]; Computed tomography scans (CT scans): The history of CT, how it works, and why we use contrast [22:45]; Ultrasound: Benefits and limitations, and a special use for the heart [36:00]; Detecting breast cancer with mammography: When is works, when you need more testing, and defining ‘sensitivity' and ‘specificity' [46:15]; Magnetic resonance imaging (MRI): How it works, defining terms, and looking at the most common types of MRI [59:00]; Brain aneurysms: Using MRI to find them and save lives [1:18:45]; Raj's unique MRI technology [1:25:15]; The risk of false positives in cancer detection, and how Raj's MRI can reduce the number of false positives (i.e., increase specificity) [1:38:45]; The unique software Raj created to pair with his MRI machine [1:46:15]; Comparing the radiation exposure of a whole-body PET-CT to Raj's equipment (DWIBS-MRI) [1:48:45]; How diffusion-weighted magnetic resonance imaging (DW-MRI) has revolutionized cancer screening [1:50:15]; Why a DW-MRI is still not a perfect test [1:54:15]; The potential for advancing MRI technology: Where does Raj think it could improve in the next 5-10 years? [1:58:00];/li> Are there any commercially available scanners that can match the resolution of Raj's images? [2:01:00]; Machine learning: When and where might machine learning/AI impact the field of radiology? [2:03:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Mohit Khera is a world-renowned urologist with expertise in sexual medicine and testosterone therapy. In this episode, Mohit provides a comprehensive overview of male sexual health. He begins with an in-depth exploration of erectile dysfunction, shedding light on its prevalence across different age groups, diagnostic methods, and its intriguing connection to cardiovascular disease. He then ventures into Peyronie's disease, penile fractures, penile enlargement treatments, prolonged erections, premature ejaculation, and anorgasmia. Shifting gears, Mohit delves into the intricate workings of testosterone, DHT, and estrogen, emphasizing their physiological significance and interplay. He explains blood tests for diagnosing low testosterone, the correlation between symptoms and blood levels in cases of low testosterone, and the pros and cons of different methodologies for increasing testosterone. He concludes with a thought-provoking conversation about the role of testosterone in patients with prostate cancer and addresses concerns surrounding DHT, finasteride, and post-finasteride syndrome. We discuss: Mohit's career path and interest in sexual medicine and infertility [3:00]; The anatomy of the male genitalia [5:45]; The prevalence of sexual dysfunction, its impact on quality of life, and the importance of seeking help [7:15]; Erectile dysfunction (ED): definition, diagnosis, pathophysiology, and more [11:00]; The history of medications to treat ED and the mechanisms of how they work [15:30]; Relationship between aging and erectile dysfunction and Mohit's approach to treating patients and prescribing medications [20:00]; The impact of lifestyle on sexual health and the association between ED and cardiovascular disease [29:30]; Causes and treatments for Peyronie's Disease, penile fracture, and more [37:30]; The value of ultrasound for ED diagnosis and management strategies [47:45]; Various treatment options for ED: injections, penile prosthesis, and more [50:15]; Priapism (prolonged erection): what is happening and when to seek treatment [57:15]; Shockwave therapy as a treatment for ED [1:02:45]; Stem cell therapy for ED [1:08:15]; Platelet-rich plasma (PRP) injections as a treatment for ED [1:12:00]; Premature ejaculation (PE): prevalence, pathophysiology, and treatment [1:14:45]; Anorgasmia: causes and treatment [1:22:00]; The interplay of sex hormones, the impact of aging, symptoms of low testosterone, and considerations for testosterone replacement therapy (TRT) [1:26:45]; Methods for increasing endogenous testosterone [1:38:45]; Testosterone replacement therapy: various forms of exogenous testosterone, weighing risk vs. reward, and more [1:52:30]; The physiology and purpose of testosterone and DHT, why some men feel fine even with “low” testosterone, personalized approaches to treating low testosterone, and more [2:02:30]; Post-finasteride syndrome [2:09:00]; The role of testosterone in prostate cancer and addressing the notion that TRT could increase risk [2:16:15]; The effects of testosterone as an adjunct to therapy for estrogen-sensitive breast cancer in women [2:27:15]; Resources for those looking for healthcare providers [2:28:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Sharon Parish is a Professor of Medicine in Clinical Medicine and Clinical Psychiatry at Weill Cornell Medical College and a prominent sexual medicine specialist who has been practicing for 30 years. In this episode, Sharon tackles the topic of women's sexual health, including the conditions associated with decreased sexual function and desire and available treatment options. She explores the influence of sexual health on overall well-being while also examining the potential effects of childbirth, birth control, metabolic health, and more on sexual function and desire. Through case studies, Sharon teases apart the differences between desire and arousal, explains the various factors that affect them, and walks through hypothetical treatment plans for the case study patients. In addition, she delves into the subject of menopause, addressing its impact on sexual health as well as the misguided fears around hormone replacement therapy. Stay tuned for next week's launch of our complementary podcast on men's sexual health. We discuss: Sharon's interest in sexual medicine and the current state of the field [3:00]; How hormones change in women over time and how that impacts sexual function [8:15]; Changes after childbirth and its impact on sexual function [11:00]; The role of metabolic health and systemic vascular health in sexual health [20:15]; Conditions associated with decreased sexual function and the importance of sexual health for overall wellbeing [26:15]; Sexual dysfunction case study #1: A 41-year-old mother of two, the sexual response cycle, and the difference between arousal and desire [38:45]; Medications that may reduce sexual desire [49:45]; The effect of birth control pills on sexual desire [56:30]; The importance of testosterone in women for sexual function and desire, and why the FDA hasn't approved exogenous testosterone as a therapeutic [1:01:15]; Challenges faced by physicians who are open to prescribing off-label testosterone for women, and Sharon's approach in managing this aspect with her patients [1:14:30]; A hypothetical treatment plan for the patient in case study #1 [1:26:45]; The role of DHEA (a precursor to testosterone) in female sexual health [1:32:15]; Case study #2: A 30-year-old woman with anorgasmia (inability to orgasm) [1:38:30]; Resources for helping women and their partners to enhance the pleasure experienced during sex, overcome anxiety, and increase desire [1:51:30]; Two drugs for premenopausal women with low desire [1:59:30]; Why treatments are potentially underutilized for both desire and genitourinary syndrome of menopause [2:13:15]; Case study #3: A menopausal woman with symptoms [2:19:00]; Addressing the misguided fears around hormone replacement therapy and cancer [2:24:15]; Symptoms and treatment of genitourinary syndrome of menopause [2:32:45]; Age 65 and beyond, and resources for finding a provider [2:37:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter delves into the critical subject of blood pressure, which is one of the three primary causes of atherosclerosis, along with high apoB and smoking. He begins by unraveling the nature of high blood pressure, its prevalence, and why it often goes undiagnosed. Peter describes in detail the proper way to accurately measure blood pressure and what determines a diagnosis. Next, Peter discusses the actionable steps one can take in response to high blood pressure, shedding light on the extent to which factors like weight loss, exercise, and nutrition can make an impact. He also explores the pharmacological options available and offers valuable insights on how to approach them. If you're not a subscriber and are listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #48 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Blood pressure and other risk factors for cardiovascular disease [2:30]; Defining blood pressure and the purpose and meaning of a blood pressure measurement [5:45]; The implications of high blood pressure and the importance of maintaining an optimal level [10:30]; The importance of accurate measurements of blood pressure and how Peter approaches the care of patients at the very top range of “normal” [21:45]; The prevalence of high blood pressure—a hidden epidemic? [24:30]; The consequences of high blood pressure on cardiovascular health, brain health, kidneys, and more [27:45]; Low blood pressure: symptoms and consequences [35:30]; How to properly measure blood pressure [37:45]; Daily variance in blood pressure and the transient changes in blood pressure during exercise [48:00]; Primary hypertension vs. secondary hypertension: what to look for [51:45]; Lifestyle factors impacting blood pressure: weight loss, exercise, and sodium [57:45]; Impact of insulin resistance and type 2 diabetes on blood pressure [1:04:45]; How sleep impacts blood pressure [1:06:45]; Pharmacologic options for managing blood pressure [1:08:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Tommy Wood is an Assistant Professor of Pediatrics at the University of Washington, where he studies brain injury and how lifestyle choices and environmental factors contribute to brain health, cognitive function, and chronic disease. In this episode, Tommy delves into the complexities of age-related cognitive decline and explores interventions to counteract it. Drawing from his experience working with Formula 1 drivers, he highlights the connection between cognitive function and the right type of demands and training leading to improvement. Next, he explores the various theories on the different types of pathology in dementia and neurodegeneration. He makes the case that a large fraction of dementia is preventable through lifestyle choices and nutrient status, and provides an in-depth overview of interventions and supplements that support cognitive function. Finally, he provides a comprehensive overview of head injuries, including concussions and traumatic brain injuries (TBIs), discussing symptoms, how to mitigate damage following an incident, and long-term management. We discuss: Tommy's professional work, unique skill sets, and interests [3:00]; Age-related decline in cognitive function and memory [5:45]; Improving brain function with the right level and type of demand [20:15]; Formula 1 as a model for how to perform under high cognitive demand and how to increase multitasking capacity [31:30]; Advice for the person reaching middle life looking to mitigate cognitive decline [37:45]; Tasks and activities that support and improve cognitive function [45:30]; Neuropathology of Alzheimer's disease: exploring the role of amyloid and tau proteins [49:30]; Why Tommy believes dementia research funding should be focused on environmental and lifestyle-based risk factors [1:05:15]; Benefits of lowering homocysteine and boosting omega-3's, and evidence-based supplements that support cognitive function [1:09:00]; A unifying theory of dementia [1:20:45]; How muscular strength can help with both the prevention and survivability of dementia [1:24:15]; Head injuries: comparing concussions against traumatic brain injuries (TBIs), mitigating the damage after an incident, and the long-term management of head injuries [1:29:15]; Is hyperbaric oxygen treatment helpful after a TBI? [1:45:45]; Supplements that aid recovery from a TBI: creatine, DHA, and choline [1:49:30]; Demands faced by F1 drivers, and testing interventions to improve their performance [1:57:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this special episode of The Drive, Peter provides a comprehensive overview of the various endocrine systems: the thyroid system, the adrenal system, and the sex hormone system (for both men and women). He walks through the basic biology and the feedback cycles that regulate the production of these hormones and discusses the various options for the treatment of hormone deficiencies. In addition, Peter delves into hormone replacement therapy (HRT), providing nuanced insights into its appropriate usage and the clinical approach he adopts when working with patients.   Peter supplements these explanations with whiteboard illustrations. For a more complete understanding, we highly recommend watching these videos over just listening. The videos can be found on our YouTube channel or on the show notes page. We discuss: The thyroid system [2:15]; The adrenal system [15:45]; The female sex hormone system [27:00]; The male sex hormone system [40:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter John Kastelein is a renowned expert in lipoprotein metabolism and atherosclerotic cardiovascular disease (ASCVD) research. In this discussion, John delves deep into familial hypercholesterolemia (FH), a genetic disorder characterized by high levels of LDL cholesterol in the blood that increases the risk of developing heart disease. He covers its definition, genetic underpinnings, and clinical identification. He then explores the therapeutic options available for the prevention and treatment of cardiovascular disease, including the captivating history of CETP inhibitors. He explains the past shortcomings of previous CETP inhibitors before underscoring the compelling potential of the latest iterations, not only for cardiovascular disease but also for conditions like Alzheimer's disease and type 2 diabetes. Moreover, he unveils the intricate role of APOE, shedding light on why the APOE4 isoform codes for a protein that significantly increases the risk of Alzheimer's disease and cardiovascular disease. Concluding the discussion, John shares a profound sense of optimism, envisioning the possibility of targeted therapeutic interventions for high-risk patients in the near future. We discuss: Familial hypercholesterolemia (FH): a genetic condition [4:30]; Differentiating between phenotype and genotype when it comes to FH [9:45]; The pathophysiology related to mutations of FH [15:30]; Clinical presentations, physical manifestations, and diagnosis of FH [22:00]; Why a small fraction of people with FH do not develop premature ASCVD [34:15]; Treatment and prevention for those with FH [39:45]; Addressing the assertion by some that elevated LDL is not casual in cardiovascular disease [52:45]; The history of CETP inhibitors, and the role of the CETP protein [55:45]; The thrifty gene hypothesis and why genes underlying FH may have been preserved [1:09:00]; The compelling potential of the latest CETP inhibitor (obicetrapib) [1:13:00]; Promising results from phase 3 trials exploring obicetrapib [1:27:45]; Why the APOE4 allele increases the risk of Alzheimer's disease, and the connection to blood lipids [1:41:30]; The role of APOE in cardiovascular disease [1:51:45]; Takeaways and looking ahead [1:57:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter delves deep into the data surrounding different forms of cold therapy, including cold water immersion, cryotherapy, and cold showers, aiming to unveil the potential benefits and drawbacks associated with cold therapy. He dissects the studies examining the effects of cold therapy on delayed onset muscle soreness (DOMS), activation of brown adipose tissue, and its potential impact on mood and as a therapeutic approach for depression. Furthermore, Peter discusses the potential negative impact cold therapy may have on muscular hypertrophy and offers his perspective on the extent to which the data support the notion of cold therapy providing longevity benefits. Finally, he also discusses the existing consensus, or lack thereof, regarding the optimal structure of an effective cold therapy protocol. If you're not a subscriber and are listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #47 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Overview of discussion on cold therapy (and a Formula 1 tangent) [1:45]; The most common cold exposure therapies [5:45]; Potential benefits of cold water immersion: a look at the data [9:30]; Comparing the effects of cold water immersion with whole-body cryotherapy [18:30]; The potential impact of cold exposure on mood and as a treatment for depression [20:45]; How do cold showers compare to cold water immersion? [28:15]; Cold exposure and the activation of brown adipose tissue (BAT) [34:15]; Things that clearly impact brain health: smoking, alcohol, sleep, head injuries, blood pressure, and more [34:15]; Exercising in cold temperatures: impact on exercise performance [38:30]; Potential downsides of cold therapy and its impact on hypertrophy, strength, and recovery [44:45]; Are the blunting effects of cold on hypertrophy due to the effects on inflammation? [50:45]; Does cold exposure offer any potential geroprotective benefits? [53:15]; Cold therapy protocols for delayed onset muscle soreness (DOMS) [56:30]; Summarizing the data and takeaways from Peter [1:01:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter JoAnn Manson is a world-renowned endocrinologist, epidemiologist, and Principal Investigator for the Women's Health Initiative (WHI). In this episode, she dives deep into the WHI to explain the study design, primary outcome, confounding factors, and nuanced benefits and risks of hormone replacement therapy (HRT). JoAnn reflects on how a misinterpretation of the results, combined with sensationalized headlines regarding an elevated risk of breast cancer, led to a significant shift in the perception and utilization of HRT. From there, they take a closer look at the breast cancer data to separate fact from fiction. Additionally, JoAnn gives her take on how one should weigh the risks and benefits of HRT and concludes with a discussion on how physicians can move towards better HRT practices. We discuss: The Women's Health Initiative: the original goal of the study, hormone formulations used, and potential confounders [4:15]; Study design of the Women's Health Initiative, primary outcome, and more [16:00]; JoAnn's personal hypothesis about the ability of hormone replacement therapy to reduce heart disease risk prior to the WHI [26:45]; The relationship between estrogen and breast cancer [30:45]; Why the WHI study was stopped early, and the dramatic change in the perception and use of HRT due to the alleged increase in breast cancer risk [37:30]; What Peter finds most troubling about the mainstream view of HRT and a more nuanced look at the benefits and risks of HRT [45:15]; HRT and bone health [56:00]; The importance of timing when it comes to HRT, the best use cases, and advice on finding a clinician [59:30]; A discussion on the potential impact of HRT on mortality and a thought experiment on a long-duration use of HRT [1:03:15]; Moving toward better HRT practices, and the need for more studies [1:10:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Rhonda Patrick, Ph.D., is a scientist with expertise in the areas of aging, cancer, and nutrition who translates complex scientific topics into actionable insights on her podcast, Found My Fitness. In this episode, Rhonda provides her latest thinking as it relates to Alzheimer's disease including the possibility of a vascular hypothesis as well as the factors that can impact disease risk such as type 2 diabetes, blood pressure, omega supplementation, exercise, sauna, and more. She also touches on cancer risk including the relationship between cancer and exercise as well as the link between alcohol consumption and cancer. Additionally, Rhonda explains her new focus on exercise and protein consumption as well as how her perspective has shifted as it pertains to fasting and time-restricted feeding. We discuss: Alzheimer's disease: Rhonda's evolved thinking on neurodegenerative diseases [2:30]; The breakdown of the blood-brain barrier in neurodegenerative disease [8:45]; An explanation for the observation that type 2 diabetes increases risk of Alzheimer's disease [15:45]; The role of omega-3 fatty acids (EPA and DHA) in brain health and prevention of neurodegeneration [19:45]; Comparing the preventable nature of type 2 diabetes, atherosclerosis, cancer, and dementia [32:15]; Blood pressure: an important modifiable lifestyle factor that can affect Alzheimer's disease risk [35:15]; Rhonda's outlook on “precision medicine” as it pertains to one's genetic predispositions [38:45]; Possible mechanisms by which exercise reduces the risk of Alzheimer's disease [45:45]; Building your aerobic pyramid: neurobiological effects of exercise, benefits of lactate peaks, and more [53:45]; Maximizing mitochondrial biogenesis: alternative training approaches and strategies [58:45]; Possible brain benefits of sauna, and Rhonda's personal protocol [1:09:30]; The relationship between cardiorespiratory fitness and dementia risk [1:15:30]; How exercise may reduce the risk of cancer [1:20:30]; The overarching impact of exercise on health, and the importance of focusing the factors that matter most [1:33:15]; Impact of alcohol consumption on breast cancer risk and overall health [1:37:15]; Exercise as an intervention for poor sleep habits [1:42:30]; The longevity benefits of consuming adequate protein and strength training to preserve muscle mass and strength [1:46:30]; How to get enough of the right kind of protein in your diet [2:05:15]; Fasting: weighing the risk vs. reward [2:12:15]; How Rhonda's views have shifted on diet and exercise [2:15:30]; How to follow Rhonda's work and more about the benefits of lactate for the brain [2:21:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this episode, Robert Sapolsky, Ph.D., discusses the widespread impact of stress on our physical and emotional health as well as the mechanisms by which it can precipitate chronic illness, dementia, depression, and more. He also provides insight into the factors that contribute to the stress response (and our ability to handle it) such as social rank, personality, environment, and genetics. Lastly, we discuss how our behavior is altered in the face of stress and how that not only has a pervasive effect on a personal level, but also on society as a whole in how we interact with each other. We discuss: Background, interest in stress, and Robert's time in Kenya studying baboons [2:45]; Physiology of a stress response, and why it's ingrained in our DNA [9:45]; Individual variation in the response to stress, and how everyone has a different optimal level [19:45]; How social rank and personality differences affect our stress response [26:30]; What's happening in the brain when faced with stressful situations? [35:00]; What makes the human brain different than all other species? [44:15]; Imprinting stress to your kids epigenetically [48:00]; The role of stress on memory and the consequences of hypercortisolemia [53:00]; The impact of subjective socioeconomic status and social media on stress levels and health [57:45]; Tips for managing stress in the modern world [1:13:15]; What Robert learned about himself studying the social behavior of baboons [1:25:30]; The multilayered factors behind every human behavior, the context of “good and bad”, and exploring the human capacity of the wild extremes of violence and altruism from moment to moment [1:30:15]; PMS: How two women with identical hormone levels can have completely different emotional experiences [1:34:45]; How much of a role do genes play in depression and other emotional states? [1:38:00]; Why is cortisol elevated under sleep deprivation? [1:46:00]; The impact of stress on cancer [1:50:30]; The impact of stress on atherosclerosis, dementia, addiction, and depression [1:57:00]; Impulsiveness, impaired judgment, and lack of empathy in times of stress [2:01:45]; What advice would Robert give his 25-year-old self? [2:08:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter goes into depth on the topic of brain health, starting with how Alzheimer's disease is diagnosed, the significance of blood-based biomarkers in diagnosis, and what the various APOE gene variants mean in terms of a person's risk of developing Alzheimer's disease. Next, Peter discusses the various strategies for preventing Alzheimer's disease and neurodegeneration. He touches briefly on exercise as a potent tool, but focuses more on lesser-known factors that could impact brain health, such as nutrition supplementation, lipid management, brain games, sauna, oral health, hearing loss, and more. If you're not a subscriber and are listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #46 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Diagnosing Alzheimer's disease [2:45]; Biomarkers for Alzheimer's disease, the C2N test, and other tools for diagnosis [7:30]; Genetic component of Alzheimer's disease: genes that confer risk [12:45]; Understanding your APOE status and why it's important to know [17:15]; The prevalence of Alzheimer's disease and other forms of dementia, and who is at higher risk [21:15]; Can the risk of Alzheimer's disease be decreased with behavioral changes? [24:15]; Overview of modifiable behaviors that potentially play a role in risk reduction of neurodegeneration [30:15]; Things that clearly impact brain health: smoking, alcohol, sleep, head injuries, blood pressure, and more [34:15]; How nutrition impacts brain health: common diets, metabolic health, energy balance, and more [46:15]; Comparing common diets: data showing the association between the incidence of Alzheimer's disease and specific diets [59:45]; Supplements: EPA and DHA, vitamin D, and B vitamins [1:13:00]; Supplements: theracurmin, cocoa flavonols, and magnesium L-threonate [1:25:15]; Impact of exercise on brain health, minimum effective dose, and the most important types of exercise [1:33:00]; Challenging the mind with brain games—does it impact neurodegeneration? [1:43:00]; The data on sauna and brain health [1:49:45]; Oral health and its association with brain health [1:52:45]; How reducing lipids can improve brain health and prevent neurodegeneration [1:55:30]; The potential impact of hearing loss on brain health and neurodegeneration [2:04:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Andy Galpin is a Professor of Kinesiology at California State University at Fullerton, where he studies muscle adaptation and applies his research to work with professional athletes. In this episode, Andy returns to the podcast and continues the conversation about training for longevity. He examines the training practices of powerlifters, Olympic weightlifters, Strongmen/women, CrossFit athletes, and sprinters in order to extract insights that can be applied to the individual wanting to optimize for longevity. Andy goes into detail about exercise load and repetition, training volume, the importance of learning proper movement patterns, the advantage of working to technical failure instead of the number of reps, and much more. Andy ties the discussion together by providing a hypothetical training plan for an individual wanting to optimize for longevity and offers advice for avoiding injury. We discuss: Review of the function and organization of skeletal muscle [3:15]; Review of muscle fiber types [9:30]; Hypertrophy: changes in muscle fibers and the underlying mechanisms that make a muscle grow [19:30]; Defining sarcoplasmic hypertrophy and how it relates to the number of reps in a set [30:15]; Training for maximum strength: what we can learn from powerlifters and a hypothetical training plan [32:45]; Ideal reps, volume, and load for the powerlifter [44:45]; What should powerlifters do on their off days? [56:45]; Are there consequences of powerlifting on long-term health? [1:02:00]; Defining Olympic weightlifting: a test of power [1:04:30]; Training principles of Olympic weightlifting [1:07:45]; Tracking power output when training [1:17:15]; 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]; Training principles of Strongmen and advice for someone new to the Strongman competition [1:36:45]; CrossFit: a combination of weightlifting movements, endurance, and circuit training [1:50:15]; Learning from elite athletes, heart rate recovery, V02 max, and other metrics [1:58:45]; Optimizing towards being a well-rounded athlete as opposed to a specialist [2:09:45]; What we can learn from the sprinters about speed, acceleration, peak velocity, and technique [2:17:45]; A training plan for the “centenarian athlete” [2:24:30]; Debunking some training and exercise myths [2:33:00]; The “do nots” of training and tips for avoiding injury [2:34:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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

Order OUTLIVE View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter After more than six years of research, planning, and writing, Peter's book, Outlive: The Science and Art of Longevity, is officially available as of March 28th. In this episode, Peter sits down with co-author Bill Gifford to provide a behind-the-scenes look into the writing process, including the motivation for making it happen, how the book evolved over the course of the writing process, and why certain topics were chosen (and omitted). Additionally, they discuss how the book is structured and touch on a few of the book's main themes to give potential readers an idea of what they can expect. We discuss: The meaning of the book's title and subtitle [3:00]; Finding the right art for the book cover [9:00]; Who is Bill Gifford, and how did he get involved in the book? [16:15]; How Peter's writing evolved over the six years it took to write this book [25:00]; The structure of the book and what people can expect to learn [29:00]; How the writing of the book and the podcast interviews have shaped Peter's thinking and approach to translating science [32:45]; Making the book stand the test of time despite the constant evolution of science and medicine [36:00]; Objective, strategy, and tactics [39:30]; Exciting possible progressions in science and medicine over the next decade [42:15]; What is holding back “medicine 3.0” from being the norm? [46:00]; How the book compares to the podcast in terms of technicality and readability for the layman [49:00]; Motivation to write the book and insights into challenges around the writing process [57:15]; Peter's decision to be the reader for the audiobook [1:10:30]; The many painstaking last-minute changes and edits that brought the book together and made it better [1:19:00]; Peter and Bill's favorite parts of the book [1:27:30]; The incredible team of people supporting the book [1:31:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Ethan Weiss is a preventative cardiologist at UCSF, an entrepreneur-in-residence at Third Rock Ventures, where he is working on a project related to cardiometabolic disease, and a previous guest on The Drive. In this episode, Ethan compares and contrasts the diagnostic imaging tools, CAC (coronary artery calcium score) and CTA (CT angiography), used to image plaque—including the latest in CTA software—and how these tools inform our understanding of ASCVD risk and guide clinical decision-making. Ethan discusses the types of plaque that cause events and the data that make a case for optimal medical therapy over stenting outside of particular cases. He explains why high blood pressure is problematic and walks through the data from clinical trials testing aggressive treatment. He talks about the best way to actually measure blood pressure, why we shouldn't simply accept that blood pressure rises with age, and how he uses different pharmaceutical agents to treat hypertension. Additionally, Ethan explains our current, but limited, understanding of the role of metabolic health in ASCVD. He discusses the impact of fat storage capacity and the location of fat storage and explains how and why there is still a residual risk, even in people who have seemingly normal lipids, don't smoke, and have normal blood pressure. We discuss: Ethan's entrepreneurial work in the cardiometabolic disease space [4:30]; Calcium scans (CAC scores) and CT angiography (CTA), and how it informs us about ASCVD risk [6:00]; Peter's historical CAC scores, CTA results, and how one can be misled [10:45]; How Peter's CTA results prompted him to lower his apoB [14:45]; Calcium scans vs. CT angiogram (CTA) [21:15]; How Ethan makes clinical decisions based on CTA results and plaque burden, and the importance of starting treatment early to prevent ASCVD [28:15]; Improved methods of CTA to grade plaque lesions and how it's shaped medical decisions such as stenting [33:45]; Why Ethan favors optimal medical therapy over stenting outside of particular situations [41:45]; The need for FFR CTA, and the potential for medical therapy to eliminate ASCVD [54:00]; The fat attenuation index (FAI) and other ways to measure inflammation in a plaque [57:30]; Statins and exercise may increase the risk of calcification, but what does this mean for risk? [59:45]; The root cause of statin hesitation despite evidence that statins are a profoundly important intervention [1:05:30]; Importance of keeping blood pressure in check, defining what's normal, and whether we should just accept higher blood pressure with age [1:10:45]; Blood pressure variability, how to best measure it, and data suggesting the enormous impact of keeping blood pressure down [1:21:00]; Drugs for treating high blood pressure recommended by the ALLHAT trial [1:35:15]; What the SPRINT trial says about the aggressive treatment of hypertension, and the risks of such treatment [1:38:15]; Confirmatory results in the STEP trial for blood pressure, and how Ethan uses the various pharmacological agents to lower blood pressure in patients [1:43:15]; The role metabolic health in ASCVD: what we do and don't know [1:51:00]; The impact of fat storage capacity and the location of fat storage on metabolic health and coronary artery disease [1:56:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter focuses the discussion on two topics getting a lot of attention recently. He first dives deep into GLP-1 agonists, most notably semaglutide and tirzepatide, which originally came to market as diabetes drugs but are now being studied and prescribed for weight loss. He walks through the data and compares the effectiveness of the two drugs, the side effects, and perhaps more importantly, his reservations around wide use of these drugs and who he would consider to be a candidate for them. Next, Peter discusses how metformin, another drug originally brought to market for diabetes management, gained popularity as a potential longevity drug even for non-diabetics. Peter gives his take on this possibility and reviews data from a more recent study investigating the question of whether metformin should be used for general “geroprotection.” 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 #45 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: The hype around semaglutide, tirzepatide, and other GLP-1 agonists for weight loss [2:30]; Overview of GLP-1 agonists and why these drugs are getting so much attention [6:15]; Defining the term “geroprotective” [13:30]; Semaglutide: background, brand names, indications, and more [15:15]; Tirzepatide: background, brand names, indications, and more [19:15]; How semaglutide and tirzepatide compare in their efficacy in terms of weight loss and other metabolic health metrics [23:45]; Data showing sustained weight loss and improved metabolic metrics with after more than a year of using semaglutide and tirzepatide [29:00]; What happens to body weight when a patient discontinues the medication? [34:45]; Noteworthy side effects of GLP-1 agonists and similar classes of drugs [40:45]; Increased resting heart rate and other concerning trends in patients using GLP-1 agonists [45:15]; Changes in body composition (body fat and lean muscle) in patients on GLP-1 agonists [50:45]; Possible reasons for the loss of lean muscle mass and tips for protecting lean mass [59:00]; GLP-1 agonists and thyroid cancer [1:01:30]; Who might be a candidate for GLP-1 agonists? [1:03:45]; The large financial cost of this class of drugs [1:08:30]; Metformin as a geroprotective drug: origin of the idea that metformin could be a longevity agent even for non-diabetic patients [1:11:30]; A 2022 study on metformin sheds more light on the question of whether metformin should be used for “geroprotection” in non-diabetics [1:21:00]; Peter's current approach with metformin for his patients [1:25:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Lewis Howes is a New York Times best-selling author, entrepreneur, speaker, and host of the popular podcast, The School of Greatness. In this episode, Lewis opens up about the various hardships and traumatic events he experienced starting at a very young age and reveals the valuable lessons he learned as he worked through those traumas to improve his emotional health. He talks about how his past hardships likely contributed to his success in business and athletics, only to leave him feeling unsatisfied and unfulfilled. Next, he discusses how many aspects of his life were suffering, the inflection point that drove Lewis to seek help, and the long but beautiful healing journey that followed. Lewis makes the case that adversity, and even trauma, can be beneficial if one finds meaning in tribulations and has the courage to face one's fears and insecurities. Finally, Lewis shares the many modalities of therapy that helped him along the way and gives advice for those wanting to find inner peace and live a fulfilling, rich, abundant, joyful life. We discuss: Lewis's upbringing and the impact of his older brother going to prison [2:45]; Finding lessons in tragedy and adversity [10:45]; Lasting trauma from being sexually abused at age 5 [13:15]; Inflection point that drove Lewis to seek help, and a beautiful experience at a therapeutic workshop [16:45]; A powerful workshop on emotional intelligence jump started Lewis's healing journey [27:30]; How being authentic can strengthen bonds with family and bring inner peace [39:30]; Comparing adversity with trauma and finding meaning in struggle [45:15]; Association between adverse childhood events and diseases in adulthood [56:15]; How addressing his issues with intimate relationships helped Lewis overcome physical pain related to his past trauma [59:15]; Healing is a journey that takes time and requires courage to face your fears and insecurities [1:08:45]; How Lewis thinks about mortality and uses it as motivation to pursue his dreams [1:13:00]; How anyone can benefit from therapy or coaching, and Lewis's advice for finding inner peace [1:22:45]; Lewis's newest book, The Greatness Mindset [1:29:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Anthony Hipolito is a sheriff's deputy in Hays County, Texas with over 24 years of experience in law enforcement. In this episode, Anthony discusses his work to spread awareness about illicit fentanyl use and the drastic increase in accidental overdoses, especially in young people. Anthony explains the deadly nature of fentanyl, including how many counterfeit drugs are now being laced with deadly doses of fentanyl. He breaks down how fentanyl is being brought to the US and how younger and younger kids are being targeted. Additionally, Anthony discusses his goal of spreading awareness to our communities and provides important advice for what parents can do. We discuss: Anthony's life of service in law enforcement [5:30]; Fentanyl: medical use, recreational use, and the recent rise in prevalence [8:30]; The story of a teenager dying from an accidental overdose of fentanyl [16:30]; The scope of deaths being caused by accidental overdoses (the majority of which are from fentanyl) [23:00]; How young kids are being targeted, and how fentanyl makes it across our borders and gets distributed [28:30]; What happens to a person when they overdose [35:30]; Whether laws around drug possession are helping or hurting, and the need to focus on helping people that feel the need to take these counterfeit drugs [37:00]; How fentanyl is being added to all kinds of drugs that you wouldn't expect [42:45]; What can we do as parents? [47:15]; Narcan: a treatment for opioid overdoses [50:15]; Importance of awareness, having conversations with kids early in life, and other key takeaways for parents [56:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter reviews the last 12+ years of his DEXA scan results revealing the changes to his body composition, lean muscle mass, visceral adipose tissue, and more. He explains how his body composition and blood biomarkers were impacted by the various dietary approaches (ketosis, fasting, high protein, etc.) and training protocols (primarily endurance, primarily strength training, etc.) he has undertaken over the years. Furthermore, Peter explains his planned approach moving forward following his most recent DEXA scan in late 2022. 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 #44 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: DEXA scans and other methods for tracking body composition [2:30]; Importance of tracking data over time to see trends [10:15]; DEXA scans in 2011: swimming, lifting, and a carb-restricted diet [12:45]; DEXA scans 2012-2014 during Peter's time on a strict ketogenic diet [18:30]; Blood biomarkers for evaluating metabolic health [25:15]; DEXA scan in 2020 after several years of regularly engaging in time-restricted feeding and prolonged fasting protocols [28:45]; DEXA scan in 2021: shifting focus to adding muscle, high-protein diet, and more strength training [40:00]; DEXA scan in early 2022: eating additional calories and adding blood flow restriction (BFR) to his workouts [44:45]; DEXA scan in late 2022: a dramatic change following shoulder surgery, and the impact of stress [48:30]; Peter's approach moving forward following his most recent DEXA scan [59:15]; A rundown of the various nutritional methods of energy restriction [1:06:15]; Current thoughts on fasting and key takeaways [1:09:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Ric Elias, the founder of Red Ventures and previous guest on The Drive, returns to discuss his evolving insights on time, relationships, parenting, and how to make the most of the gift of life. In this episode, he reflects on the changes he's made since his near-death experience during the crash landing of Flight 1549 on the Hudson River in 2009. Ric reveals many keys to living a rich life, such as aiming for continuous growth, approaching life with true intentionality, and valuing our time in accordance with that. He talks about relationships as the core of a rich life and provides insights on parenting and how we should think about our relationship with our kids as they grow older. Finally, Ric discusses the importance of staying true to yourself, the value in struggle, and finding meaning in helping others. We discuss: Reflecting on the tumultuous last few years and how his experience on Flight 1549 helped him [2:30]; Parenting: a game of tug of war that you must ultimately lose [5:00]; Importance of friendship and Ric's motivation for his recent “Friends summit” [8:00]; The impact of looking forward and focusing on growth on finishing life well [13:00]; How our relationships with our children evolve as they grow, and a new perspective on purpose [21:15]; Living with complete intention for a rich life, valuing your time, and other life lessons inspired by Ric's near-death experience on Flight 1549 [31:15]; How society's relationship with work has changed, the pros and cons of remote and hybrid working environments, and an update on his company “Red Ventures” [37:45]; Ric's dedication to philanthropy [44:45]; The Golden Door Scholars program aiming to help undocumented students with education and a future career [50:30]; Ric's journey in health and longevity [59:15]; Letting go of guilt and loving yourself [1:02:30]; The relationship between happiness and wealth [1:06:45]; Playing the “infinite game,” staying true to oneself, and ignoring the negative [1:09:15]; Speculating on the meaning of success, the drivers of greatness, and the value of struggle [1:16:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Dan Rader is a Professor at the Perelman School of Medicine at the University of Pennsylvania, where he conducts translational research on lipoprotein metabolism and atherosclerosis with a particular focus on the function of high-density lipoproteins (HDLs). In this episode, Dan goes in-depth on HDL biology, including the genesis of HDL, its metabolism, function, and how this relates to atherosclerotic cardiovascular disease (ASCVD). He explains why having high HDL-C levels does not directly translate to a low risk of cardiovascular disease and reveals research pointing to a better way to measure the functionality of HDL and predict disease risk. He also goes into detail on the role of HDL in reverse cholesterol transport and the benefits this has for reducing ASCVD. Additionally, Dan discusses the latest thinking around the association between HDL cholesterol and neurodegenerative diseases and ends the conversation with a discussion of how the latest research on HDL provides a promising outlook for ongoing trials and future therapeutic interventions. We discuss: The lipidology of apoB and apoA [4:00]; A primer on the high-density lipoprotein (HDL): genesis, structure, and more [9:30]; How the lipoprotein system differs in humans compared to other mammals [20:00]; Clarifying the terminology around HDL and apoA [25:30]; HDL metabolism [31:45]; CETP inhibitors for raising HDL-C: does it reduce CVD risk? [34:45]; Why it's so important to have hard outcome trials in the field of cardiovascular medicine [42:30]; SR-B1: an HDL receptor important for cholesterol efflux [48:00]; The association between HDL levels and atherosclerosis: are they causally linked? [53:15]; How insulin resistance is impacting HDL, and how HDL-C provides insights into triglyceride metabolism [58:00]; Disappointing results from the studies of niacin—a drug that raises HDL-C and lowers apoB [1:08:15]; HDL lipidation, dilapidation, and reverse cholesterol transport [1:12:00]; Measuring the cholesterol efflux capacity of HDL: a better predictor of ASCVD risk than HDL-C? [1:22:00]; A promising new intervention that may promote cholesterol efflux and reverse cholesterol transport [1:32:45]; The association between HDL cholesterol and neurodegenerative diseases [1:34:00]; Challenges ahead, a promising outlook, and the next frontier in lipidology [1:44:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Andy Galpin is a Professor of Kinesiology at California State University at Fullerton, where he studies muscle adaptation and applies his research to work with professional athletes. In this episode, Andy sets the foundation for the conversation by discussing the anatomy, microanatomy, and physiology of the muscle, including explaining what it actually means to undergo hypertrophy of the muscle. He then explains the difference between power, strength, speed, and hypertrophy and how those differences relate to what's happening at the cellular level and the functional unit level. Additionally, he discusses energy sources for muscles, the importance of protein for muscle synthesis, the various types of muscle fibers, and the factors that determine one's makeup of muscle fibers. Finally, Andy wraps the conversation with how he would design a program for an untrained person committed to adding muscle and functional strength for longevity. We discuss: Andy's path to expertise in exercise [3:30]; Contrasting strength, power, and force production and how they inform us about training for longevity [9:30]; Muscle energetics: Fuels that provide energy to muscles, and the importance of protein [17:45]; The structure and microanatomy of muscle, muscle fibers, and more [29:30]; Energy demands of skeletal muscle compared to other tissues in the body [39:45]; How a muscle contraction works and why it requires ATP [48:00]; Muscle fibers: modulation between fiber types with movement and changes in fibers with training and aging [53:15]; Andy's study of twins demonstrating the difference in muscle fibers between a trained and untrained individual [1:02:30]; Microanatomy of fast-twitch and slow-twitch muscle fibers [1:11:15]; Factors that determine one's makeup of muscle fibers and how adaptable they are with training [1:22:15]; Hypertrophy and what happens at the cellular level when a muscle grows [1:30:00]; How athletes quickly cut water weight and the rehydration process [1:37:30]; Different types of athletes [1:47:30]; Training advice for a hypothetical client who's untrained and wants to add muscle and functional strength for longevity [1:49:45]; Changes in muscle and muscular function that occur with aging [1:53:45]; Training plan for the hypothetical client [1:59:30]; What drives muscle hypertrophy? [2:12:15]; How to properly incorporate isometric exercises into a workout [2:19:00]; Additional training tips: movement patterns, how to finish a workout, and more [2:25:45]; Ways to incorporate high heart rate exercise into a workout plan [2:28:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter 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 More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Bill Perkins is one of the world's most successful hedge fund managers and entrepreneurs, and the author of the bestseller, Die With Zero. In this episode, Bill unpacks the Die With Zero philosophy which challenges conventional thinking related to the balance between health, wealth, and time—the three variables important for fulfillment. Bill makes the case that we should strive for maximum net fulfillment rather than net worth (or even health). He argues that we need to optimize our life to have memorable experiences before it's too late and that most people are over-saving and under-living. Bill also explains how one can apply the principles in Die With Zero to break out of “autopilot” and optimize their life to achieve maximum net fulfillment. We discuss: Bill's upbringing, background, and first job on Wall Street [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 More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Kellyann Niotis is a neurologist specializing in risk reduction strategies for the prevention or slowing of neurodegenerative disorders. In this episode, Kellyann provides an overview of the various diseases associated with neurodegeneration, including, but not limited to, Alzheimer's disease, Lewy body dementia, and Parkinson's disease. She goes in-depth on Parkinson's disease, explaining its pathology, role in movement capacity, very early warning signs, and the role of anxiety and sleep. Similarly, she provides an in-depth discussion of Alzheimer's disease, including the latest in screening, genetics, and tools/strategies for prevention. She ties the discussion together by explaining the differences and commonalities among the various diseases of neurodegeneration and the potential causative triggers, and she highlights the importance of early screening, cognitive testing, and taking the proper steps to lowering the risk of disease. We discuss: Kellyann's background, training, and interest in the brain [2:30]; A primer on neurodegeneration: different types, prevalences, interventions, and more [5:30]; Overview of Parkinson's disease and neuromuscular disorders including ALS [16:00]; Parkinson's disease: early signs, diagnosis, genetics, causative triggers, and more [17:30]; Interventions to delay or avoid Parkinson's disease, and the role of sleep and anxiety [31:15]; The challenge of standardizing early interventions for Parkinson's disease without a clear biomarker [39:45]; Alzheimer's disease: pathophysiology and the role of the amyloid and tau proteins [47:45]; Can PET scans be informative for diagnosing Alzheimer's disease? [51:15]; Tau accumulation in the brain, tau scans, serum biomarkers, and possible early detection of Alzheimer's disease pathology [57:00]; Cognitive testing explained [1:03:30]; The challenge of identifying the stage of the disease and why drugs have not shown efficacy [1:14:45]; The association between hearing loss and dementia [1:17:45]; The relationship between oral health and neurodegenerative diseases [1:21:30]; Genetic risk for Alzheimer's disease [1:24:45]; What one's mitochondrial haplotype can reveal about their risk of neurodegenerative disease [1:32:30]; The positive impact of exercise on brain health [1:37:00]; High blood pressure as a risk factor [1:40:00]; Why women are disproportionately affected by Alzheimer's disease [1:44:15]; Final takeaways: the future of understanding neurodegenerative disease and further reducing risk [1:46:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter James Clear is the author of the New York Times bestseller Atomic Habits. His extensive research into human behavior has helped him identify key components of habit formation and develop the “Four Laws of Behavioral Change.” In this episode, James provides insights into how both good and bad habits are formed, including the influence of genetics, environment, social circles, and more. He points to changes one can make to cultivate more perseverance and discipline and describes the profound impact habits can have when tying them into one's self-identity. Finally, James breaks down his “Four Laws of Behavioral Change” and how to use them to create new habits, undo bad habits, and make meaningful changes in one's life. We discuss: Why James became deeply interested in habits [1:45]; Viewing habits through an evolutionary lens [6:00]; The power of immediate feedback for behavior change, and why we tend to repeat bad habits [9:15]; The role of genetics and innate predispositions in determining one's work ethic and success in a given discipline [14:30]; How finding one's passion can cultivate perseverance and discipline [23:15]; Advantages of creating systems and not just setting goals [29:15]; The power of habits combined with self-identity to induce change [36:30]; How a big environmental change or life event can bring on radical behavioral change [50:30]; The influence of one's social environment on their habits [54:15]; How and why habits are formed [1:00:30]; How to make or break a habit with the “Four Laws of Behavior Change” [1:09:30]; Practical tips for successful behavioral change—the best strategies when starting out [1:16:15]; Self-forgiveness and getting back on track immediately after slipping up [1:30:30]; Law #1: Make it obvious—Strategies for identifying and creating cues to make and break habits [1:39:45]; Law #2: Make it attractive—examples of ways to make a new behavior more attractive [1:47:45]; Law #3: Make it easy—the 2-minute rule [1:58:45]; Law #4: Make it satisfying—rewards and reinforcement [2:03:30]; Advice for helping others to make behavioral changes [2:06:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Chris Hemsworth, best known for his role as Thor in the Marvel movies, joins Peter to discuss his recent work in the docuseries called Limitless. In the docuseries, Chris undertook extreme challenges to explore his physical and emotional limits and gain insights into longevity. In this episode, Chris discusses these many challenges—from fasting to arctic swims to 100-foot rope climbs—as well as the insights that he gained from each. Peter, who also played a role in the docuseries, guides Chris through the science of longevity, including what Chris's APOE-ε4 genotype means for his risk of Alzheimer's disease. Additionally, Chris describes how his outlook on health, happiness, work-life balance, and more have changed from his experience on Limitless. We discuss: Limitless: how Chris got involved and his overall experience filming the docuseries [3:00]; “Fasting” ‒ ep. 3 of Limitless in which Chris attempts a 4-day fast [8:15]; “Shock” ‒ ep. 2 of Limitless in which Chris swims in the Arctic Ocean [12:15]; Cold exposure: the potential physical and mental benefits [19:30]; “Strength” ‒ ep. 4 of Limitless in which Chris explores how muscle can improve longevity [21:15]; The APOE-ε4 genotype and Alzheimer's disease risk [31:30]; How Chris uses sauna [39:45]; “Acceptance” - ep. 6 of Limitless in which Chris explores the meaning of life by contemplating death [42:15]; Chris's new perspective on work-life balance [52:00]; “Stress-Proof” - ep. 1 of Limitless in which Chris learns about the impact of stress and how to manage it [54:30]; Chris reflects on his intrinsic motivation driven by both fear and purpose [58:00]; Chris reflects on his career arc and how his presence as an actor has evolved [1:01:15]; How Chris's outlook has changed since filming Limitless [1:05:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter 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]; Final takeaways on sleep [1:16:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter 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]; The Musician Treatment Foundation [3:22:00]; Gratitude and rucking [3:34:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Gerald Shulman is a Professor of Medicine, Cellular & Molecular Physiology, and the Director of the Diabetes Research Center at Yale. His pioneering work on the use of advanced technologies to analyze metabolic flux within cells has greatly contributed to the understanding of insulin resistance and type 2 diabetes. In this episode, Gerald clarifies what insulin resistance means as it relates to the muscle and the liver, and the evolutionary reason for its existence. He goes into depth on mechanisms that lead to and resolve insulin resistance, like the role of diet, exercise, and pharmacological agents. As a bonus, Gerald concludes with insights into Metformin's mechanism of action and its suitability as a longevity agent. We discuss: Gerald's background and interest in metabolism and insulin resistance (2:30); Insulin resistance as a root cause of chronic disease (6:30); How Gerald uses NMR to see inside cells (10:00); Defining and diagnosing insulin resistance and type 2 diabetes (17:15); The role of lipids in insulin resistance (29:15); Confirmation of glucose transport as the root problem in lipid-induced insulin resistance (38:15); The role of exercise in protecting against insulin resistance and fatty liver (48:00); Insulin resistance in the liver (1:05:00); The evolutionary explanation for insulin resistance—an important tool for surviving starvation (1:15:15); The critical role of gluconeogenesis, and how it's regulated by insulin (1:20:30); Inflammation and body fat as contributing factors to insulin resistance (1:30:15); Treatment approaches for fatty liver and insulin resistance, and an exciting new pharmacological approach (1:39:15); Metformin's mechanism of action and its suitability as a longevity agent (1:56:15); and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter answers a wide variety of questions, starting with a discussion on the evolution of medicine and the hopeful transition to “Medicine 3.0.” Peter recounts his unique career path and explains how he assesses risk and utilizes frameworks for decision-making. He also describes how he prioritizes his health while navigating the stresses of life, and he reviews the most exciting developments in the aging and longevity space. He finishes with some rapid-fire questions on cold plunging, strategies for lowering apoB levels, designing an exercise program for beginners, and more. If you're not a subscriber and are listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #41 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: The evolution of medicine and the transition to “Medicine 3.0” [3:00]; Peter's unorthodox career arc and what led him to this point [11:45]; What does Peter consider to be his superpowers? [22:15]; How Peter thinks about risk and explains it to his patients when making medical decisions [26:45]; The advantage of using frameworks for decision-making [37:00]; What advice would Peter give his 30-year old self? [42:15]; Why longevity is such a hard problem to solve [42:30]; The most impactful developments in the field of longevity and aging in the last 5 to 10 years [46:15]; What is Peter most excited to see develop in the health and longevity space in the next few years? [51:30]; Prioritizing healthy habits while navigating the stresses of life and time constraints [53:45]; How Peter navigates periods of high stress [58:00]; What fitness watch did Peter recently purchase? [1:03:45]; Potential benefits of cold plunging [1:05:15]; Advice for someone beginning an exercise program [1:07:30]; Strategies and tactics to lower apoB levels [1:09:00]; Interesting studies and books Peter has recently read [1:11:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Erin Michos is an internationally-known leader in preventive cardiology and women's cardiovascular health. In this episode, Erin discusses current trends in cardiovascular disease (CVD) through the lens of female biology and the observation that major adverse cardiac events in both sexes are on the rise. She walks through risk factors including LDL-cholesterol, apoB, and Lp(a) and makes the case for the importance of early preventative measures. She explains various interventions for reducing risk including a discussion of statins, GLP-1 agonists, PCSK9-inhibitors, and drugs that lower Lp(a). She goes in-depth on female-specific factors that contribute to CVD risk such as pregnancy, grand multiparity (having five or more children), oral contraceptives, menopause, and polycystic ovary syndrome (PCOS). Additionally, she explains her approach with patients as it relates to the use of hormone replacement therapy and provides advice for people wanting to lower risk both through lifestyle changes and medications. We discuss: Erin's background in preventive cardiology and women's health [2:30]; Recent trends in cardiovascular disease in women, mortality data, and how it compares to cancer [5:15]; Why early preventative measures are critical for cardiovascular disease risk [13:15]; ApoB as a causal agent of CVD, and why high apoB levels are not being aggressively treated in most cases [19:45]; The rising trend of metabolic syndrome and other factors contributing to the regression in progress of reducing cardiac events [27:00]; GLP-1 agonists—Promising drugs for treating diabetes and obesity [33:30]; Female-specific risk factors for ASCVD (pre- and post-menopause) [37:15]; Polycystic ovary syndrome (PCOS): prevalence, etiology, and impact on metabolic health, lipids and fertility [47:00]; The effect of grand multiparity (having 5+ children) on cardiovascular disease risk for women [52:30]; The impact of oral contraceptives on cardiovascular disease risk [55:00]; The effect of pregnancy on lipids and other metabolic parameters [58:45]; The undertreatment of women with familial hypercholesterolemia (FH) and how it increases lifetime risk of ASCVD [1:02:00]; How concerns around statins have contributed to undertreatment, and whether women should stop statins during pregnancy [1:09:45]; How Erin approaches the prescription of statins to patients [1:16:00]; PCSK9 inhibitors and other non-statin drugs [1:21:15]; Advice for the low- and high-risk individual [1:28:30]; The impact of nutrition, stress, and lifestyle on lipids and CVD risk [1:31:00]; Lp(a) as a risk enhancer for cardiovascular disease [1:41:15]; The effect of menopause on cardiovascular disease risk [1:50:30]; How Erin approaches decisions regarding hormone replacement therapy (HRT) for her patients [1:55:30]; The urgent need for more data on women's health [2:03:30]; Erin's goal of running a marathon in every state [2:09:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this special episode of The Drive, we have pulled together a variety of clips from previous podcasts about cardiovascular disease to help listeners understand this topic more deeply, as well as to identify previous episodes which may be of interest. In this episode, Peter highlights the importance of understanding cardiovascular disease and why early intervention is critical. He also provides a primer on lipoproteins and explains the fallacy of the terms “good cholesterol” and “bad cholesterol.” Allan Sniderman discusses the metrics measured in routine blood work – along with the limitations of those standard panels – before explaining why apoB is a superior metric for determining risk. Additionally, Tom Dayspring explains the casual role of apoB in atherosclerotic cardiovascular disease (ASCVD) and the therapeutic goals for apoB concentration, and Peter explains how early and aggressive lowering of apoB could change the landscape of cardiovascular disease prevention. We discuss: The importance of understanding atherosclerosis early in life [2:25] Defining ASCVD, its causes, and the role of cholesterol [8:00]; Why early prevention of atherosclerosis is critical [13:45]; Preventing atherosclerosis—two fatal flaws with the “10-Year Risk” approach [16:00]; Intro to lipids and lipoproteins: why there is no “bad” or “good” cholesterol [23:00]; Limitations of standard blood panels [35:45]; How Mendelian randomization is bolstering the case for apoB as the superior metric for risk prediction [39:30]; Therapeutic goals for apoB concentration [58:15]; How early and aggressive lowering of apoB could change the course of ASCVD [1:10:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Holly Baxter is an accredited practicing dietician (APD), competitive bodybuilder, fitness and nutrition educator, and coach. In this episode, Holly discusses her experience as an athlete and competitive bodybuilder. She also opens up about her struggles with mental health, her long battle with an eating disorder, and the important steps she's taken in her road to recovery. From there, she explains how she would design a nutrition and training program for a hypothetical female client wanting to improve her physique through the addition of lean muscle and loss of body fat. She explains reasonable expectations for gaining muscle and the value of a “reverse diet” for maintaining weight loss, and she shares her favorite exercises. She also talks through some female-specific training considerations such as programming, reps, volume, hormone replacement therapy, and more. We discuss: Holly's background and passion for sports and nutrition [2:00]; Holly's struggle with depression and an eating disorder [4:30]; Reflecting on her eating disorder, body image, and a wake up call [18:15]; Road to recovery: therapy, meditation, self-compassion, and a breakthrough [27:45]; The effect of competitive bodybuilding on women [39:00]; Holly's competition prep and how she guides her clients wanting to improve their physique [46:45]; Training principles for muscle hypertrophy [57:00]; Training advice for an inexperienced person wanting to build muscle [1:01:30]; Training program for a hypothetical woman wanting to add lean muscle and lose body fat [1:04:15]; Lower body lifts: Holly's approach to leg workouts with clients [1:14:00]; Upper body exercises: Holly's approach with her clients [1:24:45]; Importance of nutrition and protein during the muscle building phase [1:34:00]; Changes to nutrition and training during a fat loss phase [1:40:30]; A “reverse diet” after a cutting phase to help prevent weight gain [1:49:45]; Female-specific training considerations: programming, reps, volume, sex hormones, and more [1:53:15]; Holly's future in bodybuilding and helping struggling women [2:05:45]; Looking forward: Holly's focus on longevity, bone mineral density, and wellness [2:08:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter discusses the importance of understanding body composition and explains how to interpret the most important metrics revealed by a DEXA scan, such as lean muscle tissue mass, visceral adiposity tissue mass, bone mineral density, and more. He discusses common concerning trends in these metrics as well as strategies to address them. He goes through DEXA scan results of both male and female patient case studies and explains the prescribed intervention for each patient. Additionally, Peter answers numerous questions about dietary protein including how much we need, when we need it, and how intake should be divided throughout the day to optimize muscle protein synthesis. Finally, Peter provides his updated point of view on time-restricted feeding and fasting and how his personal approach and recommendations for patients has evolved. 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 #40 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Interpreting DEXA scans: important metrics, radiation levels, and more [2:15]; DEXA metrics: Bone mineral density (BMD) [12:00]; DEXA metrics: Visceral adipose tissue (VAT) [14:30]; DEXA metrics on lean tissue: appendicular lean mass index (ALMI) and fat-free mass index (FFMI) [20:45]; Concerning trends in BMD, VAT, & muscle mass revealed through DEXA scans [24:15]; Muscle and lean tissue loss with age and how to overcome anabolic resistance [29:15]; Female patient case studies: DEXA scan results and prescribed interventions [35:00]; Male patient case studies: DEXA scan results and prescribed interventions [42:45]; Protein consumption: recommended daily intake, Peter's personal approach, timing around workouts, and more [48:15]; What to look for with protein supplements [53:15]; Protein intake: optimal timing and how it should be divided throughout the day [55:30]; Time-restricted feeding (TRF): Peter's updated perspective [57:45]; Three strategies for reducing energy intake in over-nourished patients [1:03:15]; Prolonged fasting: potential benefits and tradeoffs [1:07:15]; A protein-supplemented version of time-restricted feeding (TRF) [1:09:30]; Theories about time-restricted feeding (TRF) and its positive influence on sleep and circadian rhythm [1:12:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube