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 “Ask Me Anything” (AMA) episode, Peter tackles a diverse set of listener-submitted questions, covering a wide range of health and performance topics. He dives into assessing cardiovascular health, discussing key biomarkers and risk factors, and breaks down various fasting approaches, including time-restricted eating and prolonged fasting. The conversation also explores the impact of alcohol on health and disease risk, fundamental principles of nutrition, and optimal protein intake. Additionally, he examines the pros and cons of ketogenic and low-carb diets, strategies for building effective exercise routines, and the role of wearables in tracking health metrics. The episode concludes with insights on emotional health, making this a well-rounded discussion packed with practical takeaways for anyone looking to optimize their well-being. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #68 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Episode format: overview of common health topics based on listener questions [1:30];How to accurately assess your cardiovascular health [3:00];The impact of fasting, time-restricted eating, and dietary restriction on metabolic health [9:00];Alcohol: health risks of consumption, limitations of research, and how to weigh the risks against social and personal enjoyment [13:45];Principles of a well-balanced diet: macronutrients, micronutrients, protein, energy balance, and more [23:45];The benefits and drawbacks of ketogenic diets: impact on satiety, metabolic health, athletic performance, lipid levels, and more [29:15];Protein: best sources for muscle growth, total intake, PDCAAS scoring system, and getting adequate amounts on plant-based diets [36:15];Creating an effective fitness routine that fits into a busy schedule [41:45];The role of rest and recovery in a workout routine [46:00];How to track fitness progress beyond just weight on a scale [48:30];The best low-impact exercises for individuals with joint issues [52:00];Wearables: insight vs. compliance, and how to use them effectively [54:45];How to evaluate the risks and benefits of medical interventions: procedural risks, complication rates, and asking informed questions [59:00];Sleep: impact on metabolic and cognitive health, and tips for improving sleep quality [1:03:45];How to identify and address emotional health challenges [1:08:30]; andMore. 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 Mike Israetel is a sports physiologist, competitive bodybuilder, and co-founder of Renaissance Periodization, where he coaches athletes and professionals in diet and weight training. In this episode, Mike shares his journey from powerlifting to academia, breaking down the core principles of resistance training, including exercise selection, volume, intensity, and frequency. He debunks common misconceptions about strength training, explains how to structure an effective program for beginners and advanced lifters, and provides candid insights into his experience with anabolic steroids, discussing their effects on muscle growth, performance, and health risks. This conversation offers a deep dive into the science of building muscle, the realities of bodybuilding at the highest levels, and explores the potential of AI-driven breakthroughs to advance human performance and longevity. We discuss: Mike’s academic journey, and early experiences in powerlifting, personal training, and sports physiology [3:30];Mike’s transition from powerlifting to bodybuilding, and his scientific and artistic approach to sculpting muscle and optimizing aesthetics [9:15];The value of strength training, time efficiency, and how it differs from endurance training [14:45];Neurological fatigue in strength training: balancing recovery and pushing the limits [26:15];The relationship between training intensity and volume, why muscle growth is not linear, and how different approaches affect results [35:00];Sustainable and effective approaches to maximizing muscle growth: training close to failure while minimizing fatigue [40:00];An efficient and effective resistance training program for beginners with limited time [49:00];Advice for finding a good trainer [1:06:30];Troubleshooting training plateaus: optimizing exercise selection, intensity, and recovery for muscle growth [1:13:30];The impact of genetics, age, and lifestyle on muscle growth [1:27:45];The importance of nutrition, protein intake, and consistency in both training and diet for muscle growth [1:31:00];The use of anabolic steroids to boost muscle growth: doses, drug combinations, and side effects [1:35:45];Long-term impact of steroid use: muscle retention, genetics and individual variability, and impact after discontinuation [1:52:15];Trade-offs of long-term usage of supraphysiologic doses of testosterone: health, performance, and Mike’s future plans [2:00:45];The potential for AI-driven medical breakthroughs to reverse aging and disease [2:07:30];The role of AI in accelerating drug development, advancing human longevity, and overcoming biological limitations [2:19:45];The philosophical implications of simulated reality, the impact of robotics on human labor and economics, and the challenge of predicting the future [2:25:15];Would having kids change Mike’s philosophy around anabolic steroid use? [2:32:15];The role of GLP-1 agonists in bodybuilding and general weight management, and the moral and philosophical debates surrounding their use [2:35:45]; andMore. 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 Tom Dayspring is a world-renowned expert in clinical lipidology and a previous guest on The Drive. In this episode, Tom explores the foundations of atherosclerosis and why atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide for both men and women. He examines how the disease develops from a pathological perspective and discusses key risk factors, including often-overlooked contributors such as insulin resistance and chronic kidney disease. He breaks down the complexities of cholesterol and lipoproteins—including LDL, VLDL, IDL, and HDL—with an in-depth discussion on the critical role of apolipoprotein B (apoB) in the development of atherosclerosis. Additionally, he covers the importance of testing various biomarkers, the impact of nutrition on lipid levels, and the vital role of cholesterol in brain health, including how cholesterol is synthesized and managed in the brain, how it differs from cholesterol regulation in the rest of the body, and how pharmacological interventions can influence brain cholesterol metabolism. We discuss: Defining atherosclerotic cardiovascular disease (ASCVD): development, risks, and physiological impact [2:45];The pathogenesis of ASCVD: the silent development over decades, and the importance of early detection for prevention of adverse outcomes [10:45];Risk factors versus risk markers for ASCVD, and how insulin resistance and chronic kidney disease contribute to atherosclerosis [17:30];How hyperinsulinemia elevates cardiovascular risk [24:00];How apoB-containing lipoproteins contribute to atherosclerosis, and why measuring apoB is a superior indicator of cardiovascular risk compared to LDL cholesterol [29:45];The challenges of detecting early-stage atherosclerosis before calcification appears [46:15]; Lp(a): structure, genetic basis, and significant risks associated with elevated Lp(a) [55:30]; How aging and lifestyle factors contribute to rising apoB and LDL cholesterol levels, and the lifestyle changes that can lower it [59:45];How elevated triglycerides, driven by insulin resistance, increase apoB particle concentration and promote atherosclerosis [1:08:00];How LDL particle size, remnant lipoproteins, Lp(a), and non-HDL cholesterol contribute to cardiovascular risk beyond apoB levels [1:21:45];The limitations of using HDL cholesterol as a marker for heart health [1:29:00];The critical role of cholesterol in brain function and how the brain manages its cholesterol supply [1:36:30];The impact of ApoE genotype on brain health and Alzheimer's disease risk [1:46:00];How the brain manages cholesterol through specialized pathways, and biomarkers to track cholesterol health of the brain [1:50:30];How statins might affect brain cholesterol synthesis and cognitive function, and alternative lipid-lowering strategies for high-risk individuals [1:57:30];Exciting advancements in therapeutics, diagnostics, and biomarkers coming in the next few years [2:09:30];Recent consensus statements on apoB and Lp(a) from the National Lipid Association (NLA) [2:12:30]; andMore. 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 introduces a brand-new roundtable format. Joined by three renowned experts in longevity science—Steven Austad, Richard Miller, and Matt Kaeberlein—the group explores the rapidly evolving field of geroscience. Together, they dive deep into topics like the relationship between healthspan and lifespan, evaluating interventions like rapamycin and senolytics, the role of epigenetic changes in aging, and whether GLP-1 receptor agonists hold geroprotective potential. They also tackle major challenges in funding and public acceptance of longevity research including how geroprotective interventions might be tested in humans. Packed with nuanced debate, humor, and groundbreaking insights, this episode is a must-listen for anyone fascinated by the science of aging. We discuss: The recent rise in public interest in longevity, misconceptions, and the link between healthspan and lifespan [3:45];Redefining healthspan, the US healthcare paradox, and separating longevity science from commercial hype [12:30];The need to redirect medical research from disease-specific models to aging-focused approaches [21:30];Proactive healthcare: rethinking health, disease, and the role of aging [30:00];Biologic age versus chronologic age, and the limitations and potential of epigenetic clocks [35:00];The utility and drawbacks of the “hallmarks of aging” as a framework for research and funding [49:30];The role of epigenetic changes in aging and the challenges of proving causality [56:45];The translational challenges of moving aging research from preclinical studies to human applications [1:03:45];Distinguishing between a biomarker of aging and aging rate indicators [1:17:15];The difficulties of translating longevity research in mice to humans, and the difficulties of testing interventions in humans [1:21:15];Exercise, aging, and healthspan: does exercise slow aging? [1:35:45];Are GLP-1 receptor agonists geroprotective beyond caloric restriction effects? [1:41:00];The role of senescent cells in aging, challenges with reproducibility in studies, and differing views on the value of current research approaches [1:46:15];How funding challenges and leadership in NIH and other institutes impact the advancement of aging-related research [2:00:15];Metformin: geroprotective potential, mechanisms, and unanswered questions [2:02:30];Canagliflozin and rapamycin as geroprotective molecules: mechanisms, dosing strategies, and longevity potential [2:10:45];Resveratrol and NAD precursors—a lack of evidence for anti-aging effects [2:22:45];The potential of parabiosis and plasmapheresis to slow aging, the challenges in translating mouse studies to humans, and possible design for human studies [2:29:45]; andMore. 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 tackles a topic that's been dominating headlines and sparking widespread concern: microplastics and plastic-associated chemicals, including BPA, PFAS, and phthalates. Peter explores the science behind these substances including how and why they've become so prevalent, the extent of our exposure, and the potential risks to our health. Most importantly, he provides a practical framework for understanding microplastics and plastic-associated chemicals and minimizing exposure while distinguishing genuine risks from exaggerated concerns. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #67 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: The complexity of the topic of microplastics and associated chemicals [1:30];Definitions: microplastics, BPA, PM2.5, phthalates, and more [6:30];The reasons behind the increase in microplastics in our environment and the surge in interest in them [12:00];The various ways that humans are exposed to microplastics and nanoplastics [14:00];Volume of plastic consumed by humans, and how the body eliminates or absorbs microplastics [16:00];How microplastics accumulate in the body, the variability in tissue accumulation, and the challenges in studying their long-term health effects [21:30];Limitations of blood tests for microplastics, and the importance of reliable biomarkers for guiding behavior and interventions [26:30];The speculative health risks of microplastics, the limitations of current research, and the need for more robust studies [29:15];The challenges of measuring microplastics in human tissues, the need for better methodologies, and the importance of critically evaluating study relevance and claims [39:45];If it’s unclear whether microplastics actually cause harm, should we still be concerned about exposure? [42:15];Strategies to minimize microplastic exposure [45:00];The financial cost and effort involved in various microplastic exposure mitigation strategies [51:00];The role of airborne microplastics in total exposure and accumulation [1:03:00];Chemicals associated with plastics, their role as endocrine disruptors, and the challenges in linking exposure to specific health outcomes [1:04:00];BPAs: role in plastic production, and its potential developmental risks [1:05:45];BPA's potential health risks: pregnancy, fertility, obesity, and diabetes, and the socioeconomic confounders in the data [1:08:30];Regulatory limits on BPA exposure, and practical considerations for reducing exposure [1:12:45];The prevalence of BPA in modern products and how to identify it [1:17:15]; PFAS: chemical structure and purpose in products [1:18:30]; Why PFAS are considered endocrine disruptors [1:19:45];The main sources of PFAS exposure, and practical steps to reduce exposure [1:21:30];The potential health risks of PFAS exposure [1:24:00];Phthalates: role in making plastics flexible and presence in personal care products [1:24:45];Why phthalates are considered endocrine disruptors [1:25:15];The main sources of phthalate exposure, and how manufacturing practices are evolving to reduce exposure [1:26:45];Practical strategies to reduce exposure to phthalates in food, air, water, and personal care products [1:28:30];Navigating microplastics and associated chemicals: a framework for personalized risk reduction [1:29:30]; andMore. 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 Olav Aleksander Bu is an internationally renowned sports scientist acclaimed for his coaching prowess with elite athletes spanning a diverse range of sports disciplines. In this episode, Olav returns to dive deeper into his groundbreaking work as an endurance coach, exercise scientist, engineer, and physiologist. The discussion explores his data-driven approach to coaching, unpacking key performance metrics like functional threshold power, VO2 max, and lactate threshold, while emphasizing the importance of consistent testing protocols. Olav shares insights on how training methodologies differ across sports, the impact of nutrition on endurance performance, and the evolving strategies for carbohydrate metabolism in fueling athletes for races. Olav concludes with a discussion on the use of artificial intelligence for optimizing training insights and performance. We discuss: Olav’s unique, engineering-driven approach to endurance coaching [2:45];Definitions and applications of key performance metrics: FTP, power, anaerobic threshold, and lactate threshold [4:45];Lactate threshold: factors affecting lactate threshold, testing protocols, and how elite athletes' efficiency affects their performance and lactate profiles [14:15]VO2 max: definition, testing, factors affecting its accuracy, and methods for optimizing oxygen utilization in elite athletes [22:15];Testing VO2 max: common mistakes and key factors to consider—preparation, warm-up, timing, and more [34:00];VO2 max testing continued: measuring instruments, testing protocols, and advanced insights gained from elite athletes [41:45];The influence of supplements like beetroot concentrate and adaptogens on VO2 max and performance [49:45];How respiratory quotient (RQ) reflects metabolic shifts during exercise, the challenges in measuring and interpreting RQ in elite athletes, and the physiological adaptations needed for prolonged endurance events [53:30];Triathlon training: the challenge of maintaining elite performance across triathlon distances, metabolic efficiency, and swimming challenges [1:03:15];How reducing drag in swimming could revolutionize performance and the role of biofeedback tools in optimizing efficiency across various endurance sports [1:07:00];How endurance athletes prioritize effort regulation using RPE, heart rate, and power output, and the role of lactate in cardiac and athletic efficiency [1:20:00];Lactate’s role as a fuel, buffering methods to combat lactic acidosis, and the variability in athlete response to bicarbonate supplementation [1:25:45];The physiological mechanisms behind differences in performance between two elite athletes: lactate transport, cardiovascular efficiency, and compensatory systems [1:33:00];Comparing interventions like acetaminophen to enhance performance in high-heat conditions versus natural adaptations to heat [1:37:15];Advancements in nutrition science, changes in cyclist body composition, and the impact of fueling strategies on athletic performance and growth [1:39:30];Optimizing endurance performance with utilization of carbohydrates, and the potential role of ketones [1:48:00];Insights gained from elite performers in the 2020 and 2024 Olympics [1:58:30];The use of artificial intelligence to optimizing training insights and performance [2:06:30]; andMore. 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 Trenna Sutcliffe is a developmental behavioral pediatrician and the founder and medical director of the Sutcliffe Clinic in the San Francisco Bay Area, where she partners with families to provide care for children facing behavioral challenges, developmental differences, and school struggles. In this episode, Trenna shares her journey into developmental and behavioral pediatrics, including her pioneering work at Stanford and her expertise in autism, ADHD, and anxiety—the "three As." She explores the diagnostic processes, the overlap and comorbidities of these conditions, and the importance of personalized treatment plans that address both medical and environmental factors. Trenna offers valuable insights into the changing prevalence of autism, the impact of evolving diagnostic criteria, and the range of therapies and medications available to support children and their families. She also discusses the challenges in accessing care and the critical need for a holistic approach that bridges healthcare and education. We discuss: Trenna’s passion for developmental-behavioral pediatrics (DBP), and the process of diagnosing anxiety, ADHD, and autism [3:15];Understanding anxiety and ADHD: assessing impairment and self-esteem and identifying anxiety and emotional well-being in young patients [9:45];The evolving diagnosis of autism: understanding the spectrum and individual needs [16:30];The dramatic rise in autism spectrum disorder (ASD): genetics, environment, expanded diagnostic criteria, and more [25:45];Exploring epigenetics and the potential multigenerational impact of environment exposures on susceptibility to certain disorders [37:15];The evolution of autism classifications, and the particular challenges for children with level 1 (mild) autism due to a lack of support [41:15];The broadening of the autism spectrum: benefits and risks of expanded diagnostic criteria and the need for future frameworks to focus on better outcomes [48:00];The overlap between ASD, ADHD, and anxiety [57:15];Understanding oppositional defiant disorder, and the importance of understanding the “why” behind a behavior when creating treatment plans [1:00:45];Defining developmental-behavioral pediatrics (DBP), and Trenna’s professional journey [1:07:00];Updated methods of ABA (applied behavioral analysis) therapy: evolution, controversies, challenges of scaling autism care, and the need for tailored interventions [1:13:45];Advice for parents trying to find and evaluate care for children with autism, ADHD, or anxiety [1:22:45]; Tailored treatments for ADHD: balancing stimulant medications with behavioral training [1:28:30]; The interplay between medication, behavioral therapy, and neuroplasticity in managing ADHD, and the potential to grow out of the need for medication [1:39:45];Using medication to treat anxiety and other symptoms in kids with autism without ADHD [1:44:45];FAQs about medicating children with ADHD: benefits, side effects, dosage, and more [1:46:30];The “superpowers” associated with level 1 autism [1:48:45];The next steps to increase support for children with ASD, anxiety, and ADHD [1:50:45]; andMore. 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 [2:00];Viewing habits through an evolutionary lens [6:15];The power of immediate feedback for behavior change, and why we tend to repeat bad habits [9:30];The role of genetics and innate predispositions in determining one’s work ethic and success in a given discipline [14:45];How finding one’s passion can cultivate perseverance and discipline [23:30];Advantages of creating systems and not just setting goals [29:30];The power of habits combined with self-identity to induce change [36:45];How a big environmental change or life event can bring on radical behavioral change [50:45];The influence of one’s social environment on their habits [54:30];How and why habits are formed [1:00:45];How to make or break a habit with the “Four Laws of Behavior Change” [1:09:45];Practical tips for successful behavioral change—the best strategies when starting out [1:16:30];Self-forgiveness and getting back on track immediately after slipping up [1:30:45];Law #1: Make it obvious—Strategies for identifying and creating cues to make and break habits [1:40:00];Law #2: Make it attractive—examples of ways to make a new behavior more attractive [1:48:00];Law #3: Make it easy—the 2-minute rule [1:59:00];Law #4: Make it satisfying—rewards and reinforcement [2:03:45];Advice for helping others to make behavioral changes [2:06:15]; andMore. 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 tackles a wide range of listener questions submitted over the past year. The discussion spans essential topics such as exercise—covering grip strength, traveling workouts, and why Peter doesn’t consider exercise an ideal weight-loss strategy—and the top biomarkers everyone should track. He also explores promising new longevity research, his evolving views on longevity, and frameworks like “objective, strategy, tactics” for personalized decision-making. The episode wraps up with insights on building good habits and a glimpse into Peter’s recent reading list. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the Special AMA show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Overview of episode topics (and Peter’s car stereo saga) [1:45];The importance of grip strength and the best methods for training it effectively [3:45];Exercise while traveling: strategies for staying active and maintaining an exercise routine [14:45];Why women should prioritize strength training [18:00];The limited role of exercise in weight loss and its greater importance in improving health, body composition, and insulin sensitivity [19:45];The “top five most important biomarkers” for assessing health [22:45];Promising developments in longevity research [28:15];The development of Klotho as a neuroprotective drug: challenges, timelines of trials, and more [34:00];Peter’s updated view on the potential of epigenome manipulation to restore aged cells to their youthful state [39:45];How reversing age-related epigenetic changes in immune cells could revolutionize our approach to aging and disease [43:30];The “objective, strategy, tactics” framework, and the importance prioritizing impactful lifestyle habits over less significant health trends [49:30];Strategies for building and maintaining good habits [56:45];How to think about drugs and supplements as part of a longevity toolkit [1:02:00];Peter’s recent reading list [1:05:15]; andMore. 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 one of the most frequently discussed and often misunderstood topics: nutrition. From weight loss and maintenance to the intricate relationship between nutrition and exercise and body composition, Peter addresses the complexities of nutrition research and explores the perennial question of whether there is a "best diet." He provides practical insights on how to choose the right diet for your unique needs, discusses the role of protein and processed foods, and outlines the key questions to help you optimize your approach to eating. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #66 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: The key nutrition-related topics to be discussed [1:30];Why Peter is not fond of discussing nutrition: limitations of nutrition research, the pitfalls of extreme certainty in dietary discussions, and the body's adaptability to varied diets [3:30];Key health metrics to monitor to evaluate the effects of nutrition [9:30];The relationship between nutrition and exercise as they relate to weight loss, maintenance, and gain [12:30];How increased muscle mass from resistance training impacts calorie burn, body composition, glucose metabolism, and overall health benefits [19:45];Comparing the impact of fitness and nutrition on lifespan and healthspan: data showing fitness to be a more significant predictor of mortality than nutrition [23:30];The myth of a “best diet,” factors that determine the effectiveness of a diet, and data suggesting benefits of the Mediterranean diet [39:00];How long to trial a new diet, the importance of measurable goals, and the appropriate timescales for observing meaningful changes [48:30];The inherent challenges in nutrition research: variability in dietary exposures, limitations in study design, the body’s adaptive nature which dampen the effects, and more [51:15];Nutritional approaches for chronic diseases like cardiovascular disease and type 2 diabetes [58:45];Emerging studies on dietary interventions for non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) [1:02:45];Practical considerations for individuals to identify the best diet for them: protein intake, energy balance, macronutrient adjustments, and micronutrient levels [1:06:00];Understanding processed vs. ultra-processed foods [1:09:15];The effects of ultra-processed foods on health [1:12:30];Questions that someone should ask themselves if they’re looking to fine-tune their diet [1:18:15]; andMore. 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 Dr. Saum Sutaria is the Chairman and CEO of Tenet Healthcare and a former leader in McKinsey & Company’s Healthcare and Private Equity Practices, where he spent almost two decades shaping the field. In this episode, Saum unpacks the complexities of the U.S. healthcare system, providing a detailed overview of its structure, financial flows, and historical evolution. They delve into topics such as private insurance, Medicare, Medicaid, employer-sponsored coverage, drug pricing, PBMs and the administrative burdens impacting the system. Saum’s insights help connect healthcare spending to broader economic issues while exploring potential reforms and the role of technology in improving efficiency. Saum highlights how choice and innovation distinguish the U.S. healthcare system, explores the reasons behind exorbitant drug prices, and examines the potential solutions, challenges, and trade-offs involved in lowering costs while striving to improve access, quality, and affordability. The opinions expressed by Saum in this episode are his own and do not represent the views of his employer. We discuss: The US healthcare system: financial scale, integration with economy, and unique challenges [5:00]; Overview of how the US healthcare system currently works and how we got here [9:45]; The huge growth and price impact due to the transition from out-of-pocket payments in the 1950s to the modern, third-party payer model [18:30];The unique structure and challenges of the US healthcare system compared to other developed nations [22:00];Overview of Medicare and Medicaid: who they cover, purpose, and impact on healthcare spending [27:45];Why the US kept a employer-sponsored insurance system rather than pursue universal healthcare [32:00];The evolution of healthcare insurance: from catastrophic coverage to chronic disease management [36:00];The challenge of managing healthcare costs while expanding access and meeting increased demand for chronic illness care [44:15];Balancing cost, choice, and access: how the US healthcare system compares to Canada [48:45];The role of the US in pharmaceutical innovation, it’s impact on drug pricing, and the potential effects of price controls on innovation and healthcare costs [56:15];How misaligned incentives have driven up drug prices in the US [1:05:00];The cost of innovation and choice, and the sustainability of the current healthcare cost expenditures in the US in the face of a shrinking workforce and aging population [1:11:30];Health outcomes: why life expectancy is lower in the US despite excelling at extending lifespan beyond 70 [1:18:45];Potential solutions and challenges to controlling drugs costs in the US while balancing choice and access and preserving innovation [1:26:15];Balancing GLP-1 drug innovation with affordability and healthcare spending sustainability [1:40:00];Reducing healthcare spending: complexities, trade offs, and implications of making needed cuts to healthcare expenditures [1:46:45];The role of government regulation, opportunities for cost savings, and more [1:56:15];Hospital billing: costs, charges, complexities, and paths to simplification [2:01:15];How prioritizing access and choice increased expenditures: reviewing the impact of healthcare exchanges and the Affordable Care Act [2:08:00];Feasibility of a universal Medicare program, and what a real path to sustainable healthcare looks like [2:15:45];The challenge of long-term care and the potential of innovation, like device-based therapies and AI, to improve health [2:23:15]; andMore. 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 [2:45];A missed experience and feeling of regret that shaped Bill’s thinking [13:45];Thinking in terms of time, and the relationship between money, time, and health [16:30];Solving for net fulfillment and allocating your time based on the seasons of life [26:45];How Bill thinks about risk, opportunity costs, and the difference between fear and risk tolerance [35:00];Optimizing for fulfillment, finding purpose outside of work, and more [41:15];Thinking about the order of experiences you want to have based on seasons of life [49:30];Bill’s unique perspective on philanthropy and a more impactful way to give money away [54:15];Applying the principles in ‘Die With Zero’ to maximize fulfillment [1:03:30];How to break out of living life on autopilot [1:13:45];When should your net worth peak? [1:17:30];Taking calculated risks [1:21:00];Bill shares a lesson from his incredible birthday [1:24:45];How Bill’s philosophy has evolved since writing Die With Zero [1:33:30]; andMore. 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 into the world of red light therapy in response to frequent questions from listeners. Peter provides a comprehensive exploration, starting with the basics of red light therapy and why it’s getting so much attention. The conversation examines the latest data on various applications, including aging, skin health, acne, wound healing, hair loss, eye health, exercise performance, metabolic health, weight loss, inflammation, injury recovery, and menstrual cramps. Peter analyzes the scientific literature on each use case and concludes with a summary table that provides an easy-to-follow breakdown of the potential benefits of red light therapy across these areas. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #65 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Overview of topics and the motivation behind exploring red light therapy [1:45];The basic science of red light therapy [3:15];The unique penetration properties of red light [6:00];What happens when tissue is exposed to red light [9:30];Exploring red light therapy’s potential to combat aging [11:00];Red light therapy for treating acne [13:00];Red light therapy for aiding in wound healing [18:45];Red light therapy for hair loss: promising benefits and practical advice [24:15];Analyzing the evidence of a positive or negative effect of red light therapy on the eyes [28:00];Red light therapy’s impact on performance and recovery [30:30];Red light therapy’s impact on metabolic health: analyzing the limited evidence for improved glucose metabolism [32:45];Red light therapy for weight loss and targeted fat reduction [36:45];Red light therapy for inflammation, chronic pain, and injury rehabilitation [41:00];Red light therapy as a treatment for menstrual cramps [43:45];Summary: promising applications of red light therapy, unsupported claims, and costs to consider [46:45]; andMore. 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 quarterly podcast summary (QPS) episode, Peter summarizes his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from his discussions on diverse topics such as dopamine and addiction with Anna Lembke, the current state and exciting future of CRISPR-mediated gene editing with Feng Zhang, how to build and maintain strong bones from youth to old age with Belinda Beck, how calorie restriction may influence longevity and metabolic health with Eric Ravussin, and the role of testosterone and TRT in prostate cancer with Ted Schaeffer. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these engaging discussions. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the episode #325 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Overview of topics to be covered [1:45];Anna Lembke episode: addiction, dopamine's role in pleasure and pain, and managing addictive behaviors [4:15];Follow-up questions about addiction: heritability, cold therapy, exercise, and strategies for breaking addictive behaviors [14:45];Feng Zhang episode: the potential of gene editing with CRISPR technology for treating diseases, and the challenges ahead [21:00];Feng Zhang’s impactful education experience, and how early exposure and curiosity-driven learning can develop scientific interest for kids [28:30];The future of CRISPR: weighing the scientific potential to combat complex diseases against ethical considerations around genetic modification [33:45];Belinda Beck episode: how to build and maintain strong bones from youth to old age [37:30];How both nutrition and exercise are crucial for bone health at all ages, and why it’s never too late to start [54:45];Eric Ravussin episode: calorie restriction, energy expenditure, exercise for weight maintenance, and more [59:00];Measuring energy intake and energy expenditure: techniques and challenges [1:09:45];ed Schaeffer episode: the nuance role of testosterone in prostate cancer, TRT, and the need for better cancer biomarkers [1:14:30];Peter’s favorite bands [1:25:45]; andMore. 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 Eric Ravussin is a world-renowned expert on obesity, metabolism, and aging whose pioneering research has shaped much of what we understand today about energy balance and caloric restriction. In this episode, Eric shares insights from his cutting-edge work on energy expenditure—a critical factor in understanding how our bodies regulate weight and appetite. He discusses methods for measuring energy output, energy balance, food intake, and appetite regulation, and explores key studies on macronutrient manipulation. Eric then delves into the CALERIE study on caloric restriction, highlighting insights related to biomarkers of both primary and secondary aging. The conversation also covers the potential of GLP-1 agonists to replicate these effects and looks ahead to how AI and technology could transform metabolic research in the coming years. We discuss: Eric’s background and current work metabolism and measuring energy expenditure [3:00];The science behind metabolic chambers for measuring energy expenditure, and the complexities of indirect and direct calorimetry [8:00];The body's regulatory systems for maintaining energy balance and the primary influence of energy intake on body weight [18:30];The epidemic of obesity and a discussion of resting metabolic rate [24:45];The impact of exercise, appetite, gut hormones, and eating patterns on weight regulation [28:45];Experiments looking at how macronutrient composition affects energy expenditure [38:45];The challenges of studying diet in real-life settings, the potential of personalized nutrition, and how public health policy could play a role in guiding nutritional habits [51:00];The importance of protein in the diet, the limitations of dietary data collection, and how AI could potentially transform nutrition science [1:08:15];How Eric’s interest in caloric restriction (CR) began with Biosphere 2, metabolic efficiency's role in aging, and goals of the CALERIE study [1:15:15];The CALERIE study: exploring the real-world impact of caloric restriction [1:28:00];Notable findings from the CALERIE study after two years: sustained weight loss, participant retention, and more [1:40:00];The effect of caloric restriction on the hallmarks of aging [1:47:00];The challenge of applying CR to the general population, the potential of drugs and exercise to mimic the effects of CR [1:55:45];Upcoming study comparing caloric restriction to time-restricting eating, and Peter’s takeaways from the discussion [2:02:45]; andMore. 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 Feng Zhang, a professor of neuroscience at MIT and a pioneering figure in gene editing, joins Peter to discuss his groundbreaking work in CRISPR technology, as well as his early contributions to optogenetics. In this episode, they explore the origins of CRISPR and the revolutionary advancements that have transformed the field of gene editing. Feng delves into the practical applications of CRISPR for treating genetic diseases, the importance of delivery methods, and the current successes and challenges in targeting cells specific tissues such as those in the liver and eye. He also covers the ethical implications of gene editing, including the debate around germline modification, as well as reflections on Feng’s personal journey, the impact of mentorship, and the future potential of genetic medicine. We discuss: Feng’s background, experience in developing optogenetics, and his shift toward improving gene-editing technologies [2:45];The discovery of CRISPR in bacterial DNA and the realization that these sequences could be harnessed for gene editing [10:45];How the CRISPR system fights off viral infections and the role of the Cas9 enzyme and PAM sequence [21:00];The limitations of earlier gene-editing technologies prior to CRISPR [28:15];How CRISPR revolutionized the field of gene editing, potential applications, and ongoing challenges [36:45];CRISPR’s potential in treating genetic diseases and the challenges of effective delivery [48:00];How CRISPR is used to treat sickle cell anemia [53:15];Gene editing with base editing, the role of AI in protein engineering, and challenges of delivery to the right cells [1:00:15];How CRISPR is advancing scientific research by fast-tracking the development of transgenic mice [1:06:45];Advantages of Cas13’s ability to direct CRISPR to cleave RNA and the advances and remaining challenges of delivery [1:11:00];CRISPR-Cas9: therapeutic applications in the liver and the eye [1:19:45];The ethical implications of gene editing, the debate around germline modification, regulation, and more [1:30:45];Genetic engineering to enhance human traits: challenges, trade-offs, and ethical concerns [1:40:45];Feng’s early life, the influence of the American education system, and the critical role teachers played in shaping his desire to explore gene-editing technology [1:46:00];Feng’s optimism about the trajectory of science [1:58:15]; andMore. 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 Belinda Beck, founder of The Bone Clinic and a leading authority on exercise physiology and bone health, delves into the science of osteoporosis, bone density, and the lifelong importance of maintaining skeletal health. In this episode, she explains how the foundation for strong bones is established during childhood, offering valuable advice for parents on optimizing bone health for their kids. She also explores how bone remodeling occurs throughout life, driven by activity, nutrition, and hormones. Belinda highlights the power of resistance training in improving bone strength, even for those at risk of bone loss, and emphasizes the role of essential vitamins and minerals in maintaining bone health. She shares practical strategies, backed by research, for preventing fractures and combating osteoporosis. We discuss: Belinda’s journey into bone health research and training [2:45];The physiology of bone and how bones adapt to mechanical loading [8:15];Bone development from birth to adulthood, why early life is a crucial period, the functions of osteoblasts and osteoclasts, and gender differences in BMD [14:00];How parents can optimize their children’s bone health through diet (calcium and vitamin D), sunlight exposure, and physical activity [27:30];The best sports and activities for promoting bone health, weight training for kids, and advice for parents [36:30];The impact of corticosteroid use on bone health in children and strategies to minimize negative effects [48:30];Advice for people in middle age to preserve bone density: physical activity and bone-loading exercises [52:00];Bone loss during the menopause transition for women: hormone replacement therapy and other strategies to mitigate BMD losses [59:30];Interpreting the bone mineral density results from a DEXA scan: T-score, Z-score, and more [1:03:00];The LIFTMOR study: testing the effects of heavy weightlifting on bone health in postmenopausal women with low bone density [1:10:15];Profound benefits of weight training outside of BMD improvements: exploring the broader impacts on patients in the LIFTMOR study [1:19:30];Guidance for people wanting to use exercise designed to improve their bone health [1:29:30]; andMore. 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 Anna Lembke is the Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic and author of Dopamine Nation: Finding Balance in the Age of Indulgence. In this episode, Anna dives deep into the biochemistry and neurobiology of addiction, exploring the critical role of dopamine and the prefrontal cortex. She shares her framework for diagnosing and treating addiction, providing real-world examples involving alcohol, gambling, cannabis, social media, and more. Anna outlines the risk factors for addiction, including inherited and nurture-based risks, explores the rise of addictions in younger generations, and discusses effective ways to address these issues with children. Additionally, she touches on healthy coping strategies, the evolution of the “marshmallow experiment,” and provides insights into GLP-1 agonists as a possible tool for addiction treatment. Finally, she reflects on the value of 12-step programs and how she navigates the emotional challenges of her work. We discuss: The role of dopamine and the prefrontal cortex in addiction [3:00];The clinical definition of addiction and the behavioral criteria for diagnosing it [13:00];Assessing alcohol use: patterns, risks, and addiction diagnosis [17:15];Applying the addiction diagnosis framework using gambling as an example [21:45];Exploring addiction variability: how nature, nurture, and access shape individual vulnerability and drug of choice [25:15];How abstinence from addictive behaviors can help reset the brain’s reward system and improve mental health [41:15];Safely abstaining from addiction substances, drugs needing medical supervision, and other key considerations [51:30];Transitioning from abstinence to long-term recovery: tools and considerations [59:00];Exploring behavioral addictions like sex addiction, and the gender differences in addiction patterns [1:08:30];Factors contributing to the increasing levels of addiction across the world [1:13:45];How online pornography can affect young boys' developing brains and lead to addictive behaviors, and strategies for parents to address this issue [1:23:30];The link between social media use and declines in mental health, potential solutions, and protective measures [1:34:45];How exercise affects brain chemistry, the role of dopamine and endorphins, and how exercise can become addictive [1:44:00];Cold-water immersion for mood regulation, and other healthy coping strategies [1:47:15];The “marshmallow experiment”: how broken promises affect behavior and trustworthy environments help children develop self-control [1:54:00];Can GLP-1 agonists be useful in treating addiction? [1:58:30];The benefits of 12-step programs [2:06:00];Why understanding a patient’s story is essential for meaningful psychiatric care [2:11:45]; andMore. 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 back into the increasingly popular topic of GLP-1 agonists, such as Ozempic and Mounjaro, which have garnered widespread attention for their ability to promote weight loss. Peter covers the latest findings in this rapidly evolving landscape, including new insights into their long-term efficacy, side effects, and what happens when the drug is discontinued. Peter also explores their impact on body composition and how resistance training interacts with these treatments. Additionally, he compares different GLP-1 receptor agonists and discusses promising new drugs in the pipeline. Finally, Peter addresses questions about the role of compounding pharmacies in the GLP-1 agonist market, compares oral vs. injectable options, and provides key considerations for anyone deciding whether to use a GLP-1 agonist for weight loss. 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 #64 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: The rapidly evolving landscape of GLP-1 agonists [2:15];The mechanism of GLP-1 agonists, their origin as diabetes treatments, and how they evolved into weight-loss drugs [6:45];Overview of new data and open questions related to the benefits and risks of GLP-1 agonists [10:30];New insights into the long-term safety of GLP-1 agonists, side effects, and more [16:45];The long-term efficacy of GLP-1 agonists, financial barriers, and more [19:45];The mechanisms behind GLP-1 agonists' ability to promote weight loss [22:00];New data on body weight changes after discontinuing the drug [26:00];Effects of GLP-1 agonists on lean mass and body composition, and the role of protein and resistance training in preserving muscle [31:30];Semaglutide vs. tirzepatide: comparing benefits and side effects [36:30];How compounding pharmacies affect availability of GLP-1 drugs and the types of formulations that are available [39:15];How do oral formulations of GLP-1 drugs compare to injectable formulations? [44:15];How do sublingual (under tongue) formulations of GLP-1 drugs compare to injectable formulations? [46:15];Guidance for using compounding pharmacies to purchase GLP-1 agonists [47:15];Data on retatrutide—a promising new triple receptor agonist in the pipeline [50:15];Can GLP-1 agonists be beneficial for sleep apnea and immune function? [57:00];Potential neuroprotective benefits of GLP-1 agonists: impact on dementia risk [1:00:45];Exploring why GLP-1 agonists may reduce the risk of cancer, kidney disease, and cardiovascular disease [1:04:00];How GLP-1 agonists might boost fertility in women [1:10:15];Early indications that GLP-1 agonists may help treat substance abuse disorders [1:12:00];Potential health risks of GLP-1 agonists: addressing thyroid cancer concerns and the unknowns due to lack of data [1:14:00];Examining the potential link between GLP-1 agonists and increased depression or suicidal ideation [1:16:00];Major remaining questions: the effects of cyclic use, rebound appetite, impact on adolescents' development, and more [1:19:30];Key considerations when deciding whether to use a GLP-1 agonist for weight loss [1:23:45]; andMore. 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 quarterly podcast summary (QPS) episode, Peter summarizes his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from each episode, covering diverse topics such as liver health with Julia Wattacheril, heart rate variability with Joel Jamieson, artificial intelligence with Zak Kohane, klotho for brain health with Dena Dubal, and lactate and lactate metabolism with George Brooks. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these engaging discussions. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the episode #319 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Overview of topics, and the positive feedback on the quarterly podcast summary format [2:00];Julia Wattacheril episode: liver health and disease [4:00];Noninvasive methods to diagnose liver conditions, and how to manage and improve liver health [16:00];Joel Jamieson episode: heart rate variability (HRV) for training and health [27:15];Practical tools for measuring HRV and how it informs training and recovery decisions [37:00];Zak Kohane episode: artificial intelligence and medicine [47:15];The current role of AI in medicine and how it could revolutionize medicine in the future [53:45];The limitations and concerns pertaining to AI [1:00:15];Dena Dubal episode: the potential benefits of klotho for brain health [1:05:00];Animal studies on klotho and brain health [1:11:00];Genetics-based variations in klotho levels in humans and their impact on cognition, disease risk, and longevity [1:14:15];Testing klotho levels, the significance of the KL-VS variant, the role of exercise in increasing klotho, and more [1:17:30];The potential of klotho as a treatment for cognitive decline and Alzheimer's disease [1:23:15];George Brooks episode: a new paradigm to think about lactate and lactate metabolism [1:27:45];The potential for lactate infusions to aid in brain recovery following a head injury [1:34:00];The relationship between lactate and cancer, and the impact of exercise on lactate levels and cancer risk [1:36:30]; andMore. Connect With Peter on Twitter, Instagram, Facebook and YouTube