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    #04 - AMA #1: alcohol, best lab tests, wearables, finding the right doc, racing, and more

    enJuly 09, 2018
    What is the role of ethanol in the body?
    How does ethanol affect the liver and brain?
    Why is moderation in alcohol consumption important?
    What are the benefits of knowing your APOE genotype?
    Which glucose monitor does Peter Attia recommend for accuracy?

    Podcast Summary

    • Understanding the Harmful Effects of AlcoholAlcohol, particularly ethanol, is a toxin that harms the body by producing a toxic substance called aldehyde. It is important to consume alcohol in moderation to reduce health risks.

      Alcohol, specifically ethanol, is a toxin to the body. While there may be some individuals who are less affected by its impact, it is important to understand that ethanol has no inherent benefits for the human body. When consumed, ethanol is metabolized by the liver and produces a toxin called aldehyde, which has negative effects on both the liver and the brain. The brain effects are what people seek when consuming alcohol, as it provides a feeling of buzz and euphoria. However, it is crucial to recognize that the dose of ethanol plays a significant role in determining its overall harm. Therefore, it is advisable to be mindful of alcohol consumption and prioritize moderation to minimize potential health risks.

    • Understanding the Impact of Alcohol on the Liver and BodyAlcohol affects the liver differently in each person, and it is vital to consider liver function and potential metabolic harm. Drinking purposefully and high-quality alcohol can be balanced, but excessive consumption should be avoided.

      The effects of alcohol on the body vary from person to person, and it is important to understand how it impacts the liver. Ethanol, the active component in alcohol, has both excitatory and depressing effects on the central nervous system. The liver processes ethanol similarly to sugar or fructose, which can lead to negative metabolic effects. It is crucial to consider an individual's liver function and the potential harm caused by alcohol consumption. Furthermore, the discussion highlights the importance of examining the underlying reasons for drinking alcohol. Drinking excessively can lead to behavior such as unhealthy eating habits. To maintain a balanced approach, it is suggested to drink purposefully and choose high-quality alcohol. However, it is also crucial to be mindful of individual preferences and be cautious about excessive consumption.

    • The truth about red wine and healthRed wine may not have as many health benefits as believed, and moderation is important when it comes to alcohol consumption.

      Consuming a glass of red wine a day is not necessarily beneficial for your health. The idea of the "French paradox" and the association between red wine and better health is based on a poor understanding of epidemiology. The compound resveratrol found in red wine, which was once believed to enhance longevity, is not present in significant amounts in a glass of red wine. Therefore, taking resveratrol supplements would be more effective if that is the desired benefit. While a single glass of wine may help some individuals unwind, the potential drawbacks of ethanol, such as increased appetite dysregulation, must be considered. Furthermore, consuming more than two drinks negatively impacts sleep quality, heart rate variability, and REM cycles. Hence, moderation is key when it comes to alcohol consumption.

    • Understanding Genetic Markers for Cardiovascular and Alzheimer's Disease RiskKnowing your LPA and APOE gene variants can help assess your risk of cardiovascular and Alzheimer's disease, enabling you to make informed decisions about lifestyle changes and medication to improve your health outcomes.

      It is important to know your LPA and APOE gene variants for better understanding your cardiovascular and Alzheimer's disease risk. LPA reflects genotype and can be measured through LP Particle number or LP little a mass. APOE exists mostly in three forms (2, 3, and 4) and plays a significant role in predicting Alzheimer's disease. Despite some physicians questioning the relevance of patients knowing their APOE genotype, there is evidence suggesting that Alzheimer's disease prevention is possible, making genotyping valuable. Furthermore, APOE genotype provides valuable insights into cardiovascular risk. Additionally, tracking LDL P or APO B, which measure LDL particles, can provide further important information. Understanding these genetic markers can help individuals assess their risk and potentially make lifestyle changes or use medication to improve their health outcomes.

    • The Importance of Focusing on Specific Cholesterol Markers and Insulin Levels in Assessing Cardiovascular HealthTotal cholesterol may not provide as much insight into cardiovascular health as the triglyceride to HDL cholesterol ratio and an oral glucose tolerance test. Monitoring these markers can help identify potential insulin resistance and intervene early.

      When it comes to assessing cholesterol levels, total cholesterol may not be as significant as other markers. According to Peter Attia, total cholesterol is only relevant in certain cases, such as when determining eligibility for a specific medication. Instead, he suggests focusing on the ratio of triglyceride to HDL cholesterol, as this may provide more valuable insights into cardiovascular health. Additionally, Attia highlights the importance of an oral glucose tolerance test (OTT) that measures insulin levels alongside glucose. While glucose levels can be monitored at home, insulin levels require laboratory testing. Attia emphasizes the need for more rigorous standards when interpreting OTT results, considering fasting and postprandial glucose and insulin levels. Overall, these markers can assist in identifying potential insulin resistance and help intervene at an early stage.

    • The importance of monitoring blood markers for health assessment and disease risk.Blood tests can provide valuable insights into a person's health and potential risk for diseases. It is important to consider changing reference ranges and not dismiss abnormal values to identify underlying health issues and assess overall well-being.

      Monitoring certain markers in blood tests can provide important insights into a person's health and potential risk for diseases such as cardiovascular disease, cancer, and neurodegenerative disease. However, it is crucial to interpret these markers in the context of changing reference ranges and evolving understanding of health conditions. For example, elevated levels of ALT, a liver enzyme, may indicate fatty liver disease, which has seen a significant increase due to higher fructose consumption. It is important to be aware of these shifts in reference ranges and not dismiss slightly abnormal values, as they may still indicate underlying health issues. Additionally, monitoring lipoproteins, inflammation markers, and endothelial dysfunction can provide valuable information about a person's risk for heart disease and stroke. Ultimately, a comprehensive approach to blood testing can help assess overall health and potential longevity.

    • The Importance of Blood Tests for Cardiovascular Health and BeyondBlood tests can offer valuable insights into cardiovascular risk and endothelial health by measuring specific markers. They can also provide clues about cancer, insulin levels, and even Alzheimer's disease risk.

      Blood tests can provide valuable insights into an individual's risk of cardiovascular disease. While specific markers like fibrinogen and c-reactive protein can indicate non-specific risk factors, more targeted markers like ox LDL and lppla2 can provide a deeper understanding of endothelial health. Additionally, tests for homocysteine and asymmetric dimethalargine (ADMA) can reveal inhibitors of nitric oxide synthase, another important factor in cardiovascular health. For younger individuals, blood tests can provide a comprehensive picture of cardiovascular risk, while older patients may benefit from additional imaging tests like CT scans and calcium scores. However, blood tests currently have limited insights into cancer, with liquid biopsies offering promise for future diagnostics. Insulin levels should also be considered as high levels can be toxic to the endothelium, even if fasting glucose appears normal. Finally, blood tests and risk stratification can also be relevant for Alzheimer's disease, as it shares similarities with cardiovascular disease in terms of risk factors and metabolic profiles.

    • The Impact of Ketogenic and Low-Carbohydrate Diets on Glucose Tolerance Tests.Glucose tolerance tests may give misleading results for those on ketogenic or low-carb diets, highlighting the need to consider dietary factors and utilize continuous glucose monitoring for accurate assessment of metabolic health.

      Glucose tolerance tests can yield misleading results for individuals following a ketogenic or low-carbohydrate diet. These individuals may experience a spike in glucose and insulin levels despite having low fasting glucose and insulin. This was demonstrated through a case where a person on a low-carb diet initially "failed" the test for kidney donation due to high glucose and insulin levels. However, after refeeding with carbohydrates leading up to the test, the results were normal. This highlights the importance of considering dietary factors when interpreting fasting glucose levels. Additionally, continuous glucose monitoring (CGM) can provide more accurate and insightful data about a patient's glucose response, making it a valuable tool for monitoring glucose levels and gaining a deeper understanding of an individual's metabolic health.

    • Continuous Glucose Monitoring: Empowering Healthier ChoicesContinuous glucose monitoring devices provide real-time feedback on blood sugar levels, helping individuals make informed choices about their diet and lifestyle for better health and glucose control.

      Continuous glucose monitoring (CGM) devices provide real-time feedback on blood sugar levels, allowing individuals to make more informed choices about their diet and lifestyle. CGMs, like the Dexcom system mentioned, have proven to be accurate and have a seamless interface with smartphones. They are valuable tools for tracking glucose levels after meals, exercise, and stress, helping users understand how their choices impact their health. These devices act as accountability coaches, discouraging unhealthy food choices by showing the immediate rise in blood sugar levels after consuming sugary or unhealthy foods. Having access to this real-time feedback encourages individuals to make healthier choices and maintain control over their glucose levels. Despite the challenges posed by children and their impact on the food environment, CGMs provide a helpful means of maintaining healthy eating habits.

    • The Influence of our Environment on Eating Habits and the Importance of Family History in Assessing Health Risks.Our environment greatly affects our eating habits, and being aware of our family's medical history can provide valuable insights to make informed decisions about our health.

      Our environment plays a crucial role in determining our eating habits, and we are most vulnerable to unhealthy choices in the places we spend most of our time. Peter Attia admits that he struggles to resist unhealthy foods when he is at home, despite his efforts to maintain a healthy diet. Having kids adds to the challenge, as there is more temptation to keep kid-friendly foods around. Additionally, he highlights the significance of family history in assessing our health risks, stating that it often provides greater insights than genetic markers or whole genome sequencing. Therefore, being aware of our family's medical history can help us make more informed decisions about our health and take preventive measures accordingly.

    • Understanding Family History and Choosing the Right Healthcare ProviderConsider your family's medical history when assessing your own health risks, and prioritize advocacy and expertise when choosing a healthcare provider.

      A person's family history plays a crucial role in predicting their health outcomes. By examining the patterns of diseases in a family, such as heart disease, cancer, and dementia, healthcare professionals can gain valuable insights into an individual's potential risks. However, it's important to consider other factors, such as lifestyle choices and genetic variations, that may influence disease development. When seeking a healthcare provider, it's crucial to prioritize specific qualities. Advocacy is essential, as a physician who can guide and support patients through medical challenges is invaluable. Additionally, a doctor's ability, rather than just their affability, should be prioritized. Finding a balance between expertise and rapport is crucial for effective healthcare.

    • Importance of finding the right doctor-patient relationship for effective healthcare.Patients should prioritize finding doctors who they feel connected to and can communicate effectively with, while also considering factors such as accessibility, pricing, knowledge, and reputation.

      Finding the right doctor-patient relationship is crucial for effective healthcare. It's important for patients to feel connected and aligned with their doctors, allowing for better communication and understanding. If a patient feels like they can't connect or be brought along by their doctor, it may be necessary to find someone else who can communicate in a way they prefer. Availability is also an important factor, as some may prefer doctors who are accessible 24/7. When considering concierge doctors, it's essential to understand the differences in pricing and services offered. Additionally, the ability to stay updated with medical advancements and a passion for learning is vital for doctors to provide exceptional care. Rather than focusing on labels, it is more valuable to evaluate doctors individually based on their knowledge and reputation. Referrals from respected doctors can also be valuable in finding a trusted healthcare provider.

    • Finding the Right Doctor and Mastering Cornering in DrivingBe proactive in finding the right doctor and don't settle for less. Similarly, in driving, mastering corners requires understanding the optimal line and making necessary adjustments in speed and steering.

      Finding a good doctor may take time, and it's important to actively participate in your own healthcare. If you're not satisfied with your current doctor, don't be afraid to switch and keep searching until you find the right one. Pay attention to how the doctor reacts to your questions and interest in your own health. A good doctor will not be intimidated or put off by an engaged and curious patient. In another topic discussed, racing, the hardest thing to learn as a driver is vision and understanding the optimal line to take on a racecourse. This involves knowing where the car needs to be at every moment in time. Cornering is the most challenging aspect of driving, with understeer and oversteer being common problems that can be corrected with proper adjustments in speed and steering.

    • Mastering the Art of Controlled OversteerCorrecting oversteer in a race car involves adjusting the angle of the front wheels, pausing for correction, and smoothly modulating throttle and brake pressure. Watching experienced drivers like Chris Harris can offer valuable insights.

      Learning to correct oversteer in a race car is a challenging yet crucial skill. Oversteer occurs when the back end of the car starts to slide out faster than desired, causing the car to turn faster than the front wheels are steering. It is not a visually recognized cue but rather something felt by the driver. To correct oversteer, the initial instinct is to change the angle of the front wheels, followed by a pause for correction and then getting back on the throttle. Modulating throttle and brake pressure smoothly is also important for different driving sensations and control. Watching experienced drivers like Chris Harris can provide insights and inspiration for mastering the art of controlled oversteer.

    • Ayrton Senna - The Greatest Race Car Driver and HumanitarianAyrton Senna's exceptional talent on the track and his dedication to making a positive impact in Brazil's fight against poverty define his enduring legacy.

      Ayrton Senna was a truly remarkable race car driver, considered by many as the greatest of all time. His natural talent and raw ability were evident from the start, as he effortlessly outperformed experienced drivers in their own cars. Beyond his skills on the track, Senna's passion and emotional approach set him apart. He deeply cared about his home country, Brazil, and dedicated a significant portion of his wealth to fight poverty there. Even after his untimely death, Senna's impact continues to be felt, with organizations like the Senna Foundation making a difference in Brazil. Senna's era in Formula 1 is often regarded as the golden age, where drivers played a more significant role and showcased incredible feats of skill. While today's drivers like Lewis Hamilton are undoubtedly talented, advancements in technology have made the cars safer and more efficient. Nonetheless, Senna's legacy remains an inspiration for both fans and aspiring drivers alike.

    • Limitations of iRacing as a Driving SimulatoriRacing is a valuable tool for improving driving skills and understanding racing scenarios, but it does not fully replicate the challenges and sensations of real-life driving, requiring real-world experience for complete skill development.

      IRacing, a high-end software program used in simulators, can improve various aspects of driving skills. However, it does have limitations. One drawback is that the simulator cannot fully replicate the feeling and visual cues of oversteer, making it harder to correct in the virtual environment compared to real-life situations. Additionally, the physiological stress experienced in a real car, such as extreme temperatures and physical discomfort, cannot be replicated in the simulator. These real-world challenges require practice and concentration to overcome. Despite these limitations, iRacing still offers valuable training for drivers, enhancing their overall skills and understanding of different racing scenarios. It serves as a useful tool but should be supplemented with real-world experience to fully develop the necessary skills and adaptability needed in racing.

    • The Benefits of Simulators in Skill Development and TrainingSimulators provide a cost-effective and safe platform for practicing and improving driving techniques, allowing racers to gain valuable experience on different tracks and with various cars.

      Simulators are incredibly beneficial for learning and improving skills without the high cost and potential risks involved. Just like pilots spend most of their time in simulators before flying, racing car drivers can use simulators to gain valuable experience on different tracks and with different cars. Simulators provide a cost-effective and safer way to practice and become proficient in driving techniques. Additionally, simulators offer a wide range of car options, allowing drivers to experience the thrill of driving different types of vehicles, even if they are difficult to handle in real life. Overall, simulators offer a rich and enjoyable learning experience for both professional racers and enthusiasts alike.

    • The Importance of Proper Nutrition and Fueling Strategies in Athletic PerformanceTailoring nutrition and fueling strategies to individual needs is crucial for optimal athletic performance, emphasizing the importance of minimizing reliance on glycogen and glucose, and incorporating branch chain amino acids.

      Peter Attia reflects on his experience as a swimmer and discusses the importance of proper nutrition and fueling strategies during athletic activities. He admits that he was not a natural swimmer and struggled with stroke mechanics. He describes the different stages of competence and how he never reached the final stage. He also mentions the types of high-carb fuels he used to rely on, but now realizes he would have preferred a highly fat-adapted diet. He emphasizes the significance of minimizing reliance on glycogen and glucose, and highlights the importance of branch chain amino acids. Additionally, he discusses the techniques he used to consume food and fluids while swimming, using either a kayak or a long pole with a cup attached. Overall, the key takeaway is that proper nutrition and fueling strategies are crucial for athletic performance and should be tailored to individual needs.

    • Consistency and Injury Prevention: Peter Attia's Approach to ExerciseRegular exercise, injury prevention, and prioritizing consistency are more important than specific goals or impressive achievements in maintaining a healthy and balanced fitness routine.

      Peter Attia emphasizes the importance of consistency in exercise and prioritizing injury prevention. Despite his busy schedule, Attia maintains a non-negotiable routine of weightlifting three days a week. On the other four days, he incorporates cycling on either a Peloton or a Wahoo KICKR trainer. Attia recognizes the need to reprioritize swimming, as he misses the physical and mental benefits it offers. He also briefly took up running again but got distracted and focused on cycling instead. Rather than training for specific goals or impressiveness, Attia emphasizes the importance of exercising regularly and dedicating time to movement prep and injury prevention. While he acknowledges the incredible achievements of some triathletes, Attia realistically assesses his own capabilities in completing an Ironman.

    • The importance of exercise for longevity and health spanRegular exercise can delay the onset of diseases, improve glucose disposal and muscle efficiency, and maintain muscle mass and overall fitness as we age. Prioritizing safety and consistency in exercise enhances our quality of life.

      Exercise plays a crucial role in both life span and health span. While the best exercise for longevity may still be unknown, it is clear that exercise can delay the onset of diseases like atherosclerosis, cancer, and neurodegenerative diseases. The mechanisms through which exercise improves health span include the disposal of glucose and increased muscle efficiency. However, it is important to find the right balance, as excessive exercise can have negative effects. Lifting weights, especially as we age, is particularly beneficial in maintaining muscle mass and overall fitness. It is also important to prioritize safety and avoid unnecessary risks when engaging in weightlifting. By staying physically active and consistently exercising, we can enhance the quality of our lives as we age.

    • The Significance of Maintaining Strength and Using Technology for Health Monitoring as We AgeAs we grow older, it is crucial to prioritize strength and physical capability while also leveraging wearable devices like continuous glucose monitors and Aura Rings to track and improve our health.

      As we age, it is important to make compromises while still maintaining strength and physical ability. Peter Attia emphasizes the significance of not compromising the expectation of being strong and able to carry heavy loads, like walking through an airport with two fifty-pound bags. If we struggle with physical tasks in our forties, it will be even more challenging to maintain our strength and mobility in our seventies. Attia also discusses the importance of wearable devices for tracking health parameters, particularly continuous glucose monitors (CGMs). While there are various options available, he recommends the Dexcom CGM for its accuracy. However, the challenge lies in the cost and the need for these devices to meet strict medical standards. Attia hopes that in the future, CGMs will be more affordable and convenient, possibly even as small as contact lenses. Additionally, he praises the accuracy of the Aura Ring for sleep tracking, although it may need to be removed during certain exercises like deadlifts. Ultimately, the conversation highlights the importance of maintaining strength and using technology to monitor and improve our health as we age.

    • Immersion and Mentorship: Powerful Tools for Deep LearningTo truly understand a topic, immerse yourself in it and learn from experienced mentors, absorbing as much information as possible to gain valuable insights.

      Immersing oneself in a topic and learning from experts who have already delved deeply into it is an effective way to gain a thorough understanding. Peter Attia shares his approach to learning, which involves total immersion and seeking out mentors who have extensive knowledge and experience in the subject matter. By dedicating oneself to absorbing as much information as possible and engaging with complex cases, valuable insights can be gained. Attia emphasizes the importance of finding a teaching style that resonates with the individual, as this can greatly enhance the learning process. This strategy of seeking out expertise and immersing oneself in the topic can expedite the learning journey and lead to a comprehensive understanding of the subject.

    • The Art of Effective Teaching and Simplifying Complex Concepts in the Digital Age.Choose teachers who resonate with you, evaluate the credibility of sources, find customized learning strategies, and hire experts to accelerate the learning process.

      When it comes to learning, it's not just about finding the smartest person or the one who knows the most about a topic. It's about finding someone who can effectively teach and communicate that knowledge to you. Peter Attia emphasizes the importance of choosing the right teachers who resonate with you and can simplify complex concepts. In today's digital age, there is an abundance of information available, but it's essential to evaluate the credibility and effectiveness of the sources. Finding customized learning strategies, whether through listening, reading, or face-to-face interactions, is crucial. Additionally, Attia highlights the value of hiring experts who can condense vast amounts of information into digestible summaries to accelerate the learning process.

    • Effective Learning Strategy for Complex TopicsStart with review articles, watch lectures, and find a well-written book to gradually understand complex topics. Synthesize information and seek clarification from experts for an effective learning experience.

      Learning complex topics requires a strategic approach. Peter Attia suggests starting with review articles that provide an overview of the subject matter. Even though initially most of the content may be difficult to understand, immersing oneself in the material gradually leads to comprehension. Attia highlights the value of watching lectures and talks where experts explain the concepts in a simplified manner. Additionally, finding a well-written book on the topic can make the learning experience enjoyable and effortless. Attia emphasizes the importance of synthesizing and condensing information, as well as reaching out to experts for clarification. Overall, an effective learning strategy involves a combination of reading, watching, and interacting with knowledgeable individuals in the field.

    • The Value of Seeking Help from ExpertsConnect with experts for valuable insights and perspectives, continuously learn and immerse yourself in a subject to gain knowledge, and avoid wasting time and energy on irrelevant matters.

      Seeking help and guidance from experts can provide valuable insights and perspectives. The speaker, Peter Attia, emphasizes the importance of reaching out to experts in order to gain a deeper understanding of a topic. He admits that his ego sometimes gets in the way of seeking help, but recognizes that this defense mechanism may have hindered his research. Attia highlights the benefits of connecting with researchers and authors, as they can offer additional insight and provide a different perspective compared to reading papers alone. Moreover, Attia encourages continuous learning and immersing oneself in a subject to acquire knowledge, stressing that there is an abundance of information available for anyone willing to explore and engage. Lastly, Attia reflects on the significance of not dwelling on things that cannot be changed and avoiding wasting time and energy on irrelevant matters.

    • Reflecting on Upbringing and BeliefsEmbrace the evolution of knowledge, be present with loved ones, and approach learning with humility and open-mindedness.

      We should be cautious about the way our upbringing and past experiences shape our drive and beliefs. Peter Attia reflects on his childhood and acknowledges that while he wishes he had learned certain things, he is also grateful for the time he invested in training. He realizes that he has spent too much time worrying about things he cannot change and not enough time being present with the people who matter. Furthermore, he admits that his drive and obsession may stem from unhealthy events that he doesn't want to discuss. When it comes to forming beliefs, Attia emphasizes the importance of recognizing that knowledge evolves and that there are no definitive proofs in science. He advocates for seeking knowledge and embracing nuance rather than striving to be right all the time. By adopting this mindset, we can approach learning with humility and open-mindedness.

    • Embracing uncertainty for better decision-makingAcknowledge ignorance, consider probabilities, and be cautious when making decisions in complex areas like medicine or nutrition. A willingness to learn and adapt is important for effective decision-making in the face of uncertainty.

      Certainty in decision-making is often elusive, especially in complex areas like medicine or nutrition. Peter Attia emphasizes the importance of acknowledging our own ignorance and being humble in the face of uncertainty. He cautions against relying on absolute certainty and encourages a more nuanced understanding of probabilities and incomplete knowledge. While it is necessary to make decisions and take action, it is also crucial to consider risk and weigh the potential outcomes. Being paralyzed by uncertainty is not productive, but blindly trusting in one's own knowledge is also problematic. Instead, a thoughtful and cautious approach, coupled with a willingness to learn and adapt, can lead to better decision-making in the face of uncertainty.

    • Finding a personal approach to diet and nutritionPersonalizing your diet is crucial for success, as everyone's body responds differently. It's important to find what works best for you, rather than following a one-size-fits-all approach.

      It's important to have a balanced approach to diet and nutrition. Peter Attia explains that while he experienced numerous benefits on a ketogenic diet, he decided to discontinue it because he missed certain foods and felt the need to reintroduce them into his diet. He also acknowledges that not everyone responds the same way to a ketogenic diet and that it may not be suitable for everyone. Instead, he now follows a simpler set of principles, avoiding junk food and opting for healthier carbohydrate sources like potatoes and rice. This highlights the importance of personalizing your diet and finding what works best for you, rather than subscribing to a one-size-fits-all approach.

    • Peter Attia's Balanced Approach to Eating for Health and Lifestyle.It is important to find an eating plan that aligns with one's health goals while also being manageable in the context of everyday life.

      Peter Attia follows a specific eating routine, incorporating a high-fat shake called the Peter Kaufman and focusing on low-carb options. He pays close attention to his glucose levels throughout the day and prioritizes maintaining stable blood sugar levels. Despite the temptation to indulge in desserts or go back on a ketogenic diet, Peter prefers a balanced approach that includes plenty of vegetables, salad, and a rotation of meats with occasional servings of potatoes or rice. The decision not to return to a strict ketogenic diet is influenced by the challenges it presents in managing meals with his children. This conversation highlights the importance of finding an eating plan that is both effective for individual health goals and manageable in the context of one's lifestyle.

    • The Challenges of a High-Calorie Ketogenic Diet and the Importance of Understanding the Technical AspectsMaintaining a ketogenic diet requires careful planning and effort, including consuming unconventional foods. It also emphasizes the importance of informed decision-making and awareness in dietary choices and medical interventions.

      A ketogenic diet requires careful planning and effort, especially when it comes to maintaining the right ratio of fat to protein and carbs. Peter Attia explains the challenges he faced while being on a high-calorie ketogenic diet, which included consuming large amounts of unconventional foods like tubs of sour cream. This highlights the importance of understanding the technical aspects of a ketogenic diet and the effort it takes to sustain it. Additionally, the conversation touches on other topics like statins, smart drugs, and hormone replacement therapy, indicating that these subjects will be explored further in future discussions. Overall, it underscores the need for informed decision-making and awareness when it comes to dietary choices and medical interventions.

    • Upcoming Podcasts: Exploring Various Health Topics and Sharing Valuable InsightsBy discussing a range of subjects and approaching them holistically, Peter Attia aims to provide valuable knowledge and insights to his audience, enhancing their understanding of health-related topics.

      Peter Attia plans to discuss various topics, including depression, autophagy, ketosis, and exercise, in upcoming podcasts. He is excited to engage with experts in these fields and share valuable information with his audience. Despite acknowledging the potential drawbacks of social media, Peter recognizes the importance of using platforms like Twitter to connect with his followers and address their questions. By addressing a wide range of topics, from NAD and nicotinamide riboside to APOE and exercise strategies, Peter aims to provide valuable insights and knowledge to his listeners. This conversation highlights the importance of exploring different subjects and approaching them from a holistic perspective to gain a better understanding of various health-related topics.

    Recent Episodes from The Peter Attia Drive

    #316 - AMA #63: A guide for hair loss: causes, treatments, transplants, and sex-specific considerations

    #316 - AMA #63: A guide for hair loss: causes, treatments, transplants, and sex-specific considerations

    View the Show Notes Page for This Episode

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    In this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of hair loss, exploring its relationship with aging and its impact on quality of life. The conversation focuses on androgenic alopecia, the most common form of hair loss in both men and women, and covers the differences in patterns and causes between the sexes. Peter delves into the right timing for treatment, breaking down various options such as minoxidil and finasteride, low-level laser therapy, platelet-rich plasma injections, and more. Additionally, Peter outlines the pros and cons of the two primary hair transplantation methods and concludes with practical advice on selecting the right specialist or treatment team for those facing hair 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 #63 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

    We discuss:

    • The impact of hair loss on emotional health [2:15];
    • The prevalence, patterns, and causes of hair loss in men and women [5:15];
    • The genetic and hormonal causes of hair loss, and the role of dihydrotestosterone (DHT) in androgenic alopecia [8:45];
    • The visual differences in hair loss patterns between men and women, and the importance of consulting a specialist to rule out non-genetic causes of hair loss [13:30];
    • How genetic predisposition influences the risk of androgenic alopecia, and how early detection through diagnostic tools and blood tests can help manage risk more effectively [16:45];
    • Ideal timing for starting treatment: why early treatment is crucial for effectively managing hair loss [19:30];
    • The various FDA-approved treatments for androgenic alopecia, their mechanisms, and additional off-label treatments commonly used to manage hair loss [24:30];
    • Topical minoxidil—the most commonly recommended starting treatment for hair loss [30:15];
    • Oral vs. topical minoxidil: efficacy, ease of use, and potential side effects that must be considered [33:45];
    • Finasteride for treating hair loss: efficacy, potential side effects on libido, and the need for careful PSA monitoring in men to avoid missing early signs of prostate cancer [37:15];
    • Other effective hair loss treatments for women: boosting hair density with spironolactone gel and ketoconazole shampoo as part of a comprehensive strategy [41:30];
    • Low-level laser therapy: effectiveness, costs, practicality, and a comparison of in-office treatments with at-home devices [49:00];
    • Platelet-rich plasma (PRP) as a treatment for hair loss: potential effectiveness, varying protocols, and significant costs [53:45];
    • Hair transplant for advanced hair loss: criteria and considerations [58:00];
    • Types of hair transplants: follicular unit transplantation (FUT) vs. follicular unit extraction (FUE) [1:02:00];
    • The financial cost of hair transplant surgery, and what to consider when seeking affordable options [1:06:15];
    • The potential risks and downsides of the various hair transplant procedures [1:09:30];
    • Post-procedure care for hair transplants and whether the procedure must be repeated periodically [1:16:30];
    • Combining different hair loss treatments: benefits, risks, and considerations [1:18:30];
    • Emerging hair loss treatments with limited data [1:21:00];
    • Key considerations for selecting the right treatment plan for hair loss [1:22:00];
    • A summary of the different considerations for men and women facing hair loss [1:24:30];
    • Practical advice on selecting the right specialist or treatment team [1:26:15]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enSeptember 09, 2024

    Improve your decision-making, frameworks for learning, backcasting, and more | Annie Duke (#60 rebroadcast)

    Improve your decision-making, frameworks for learning, backcasting, and more | Annie Duke (#60 rebroadcast)

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    In this episode, former World Series of Poker champion and author Annie Duke explains how poker is a pertinent model system for decision-making in the real world, a system which blends imperfect information with some unknown percentage of both luck and skill. Annie breaks down the decision-making matrix, revealing how we often focus too narrowly on just one of the four quadrants, missing out on valuable learning opportunities in the remaining 75% of situations. She delves into how our tendency to evaluate only negative outcomes leads to a culture of risk aversion. This mindset, she argues, stifles the kind of bold decision-making necessary for progress and innovation across various fields, from poker and sports to business and medicine. Annie also introduces a robust framework for learning and the levels of thought required to excel in any domain. Finally, she discusses a strategy called “backcasting”, a concept that resonated deeply with Peter in terms of how he thinks about extending healthspan.

    We discuss:

    • Annie’s background, favorite sports teams, and Peter’s affinity for Bill Belichick [1:30];
    • Chess vs. poker: Which is a better metaphor for decision-making in life (and medicine)? [6:45];
    • Thinking probabilistically: Why we aren’t wired that way, and how you can improve it for better decision-making [12:30];
    • Variable reinforcement: The psychological draw of poker that keeps people playing [19:15];
    • The role of luck and skill in poker (and other sports), and the difference between looking at the short run vs. long run [32:15];
    • A brief explanation of Texas hold ‘em [41:00];
    • The added complexity of reading the behavior of others players in poker [47:30];
    • Why Annie likes to “quit fast,” and why poker is still popular despite the power of loss aversion [52:45];
    • Limit vs. no-limit poker, and how the game has changed with growing popularity [55:15];
    • The advent of analytics to poker, and why Annie would get crushed against today’s professionals [1:04:45];
    • The decision matrix, and the “resulting” heuristic: The simplifier we use to judge the quality of decisions —The Pete Carroll Superbowl play call example [1:10:30];
    • The personal and societal consequences of avoiding bad outcomes [1:21:45];
    • Poker as a model system for life [1:31:30];
    • How many leaders are making (and encouraging) status-quo decisions, and how Bill Belichick’s decision-making changed after winning two Super Bowls [1:35:15];
    • What did we learn about decision-making from the Y2K nothingburger? And how about the D-Day invasion? [1:39:30];
    • The first step to becoming a good decision maker [1:43:00];
    • The difference between elite poker players and the ones who make much slower progress [1:49:45];
    • Framework for learning a skill, the four levels of thought, and why we hate digging into our victories to see what happened [1:52:15];
    • The capacity for self-deception, and when it is MOST important to apply four-level thinking [2:00:30];
    • Soft landings: The challenge of high-level thinking where there is subtle feedback and wider skill gaps [2:11:00];
    • The benefits of “backcasting” (and doing pre-mortems) [2:13:30];
    • Parting advice from Annie for those feeling overwhelmed (and two book recommendations) [2:21:30]; and
    • More.

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    The Peter Attia Drive
    enSeptember 02, 2024

    #315 ‒ Life after near-death: a new perspective on living, dying, and the afterlife | Sebastian Junger

    #315 ‒ Life after near-death: a new perspective on living, dying, and the afterlife | Sebastian Junger

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    Sebastian Junger is an award-winning journalist, bestselling author, and previous guest on The Drive. In this episode, Sebastian returns to discuss his latest book, In My Time of Dying: How I Came Face to Face with the Idea of an Afterlife. This episode delves into Sebastian's profound near-death experience and how it became the catalyst for his exploration of mortality, the afterlife, and the mysteries of the universe. They discuss the secular meaning of what it means to be sacred, the intersection of physics and philosophy, and how our beliefs shape our approach to life and death. He also shares how this experience has profoundly changed him, giving him a renewed perspective on life—one filled with awe, gratitude, deeper emotional awareness, and a more engaged approach to living.

    We discuss:

    • How Sebastian’s near-death experience shaped his thinking about mortality and gave him a reverence for life [3:00];
    • The aneurysm that led to Sebastian’s near-death experience [6:30];
    • Emergency room response, his subsequent reflections on the event, and the critical decisions made by the medical team [16:30];
    • Sebastian’s reaction to first learning he nearly died, and the extraordinary skill of the medical team that save his life [26:00];
    • Sebastian’s near-death experience [37:00];
    • The psychological impact of surviving against overwhelming odds [48:00];
    • Ignored warning signs: abdominal pain and a foreshadowing dream before the aneurysm rupture [54:30];
    • Sebastian's recovery, his exploration of near-death experiences, and the psychological turmoil he faced as he questioned the reality of his survival [58:15];
    • A transformative encounter with a nurse who encouraged Sebastian to view his near-death experience as sacred [1:03:30];
    • How Sebastian has changed: a journey toward emotional awareness and fully engaging with life [1:08:45];
    • The possibility of an afterlife, and how quantum mechanics challenges our understanding of existence [1:15:15];
    • Quantum paradoxes leading to philosophical questions about the nature of reality, existence after death, and whether complete knowledge could be destructive [1:26:00];
    • The sweet spot of uncertainty: exploring belief in God, post-death existence, and meaning in life [1:37:00];
    • The transformative power of experiencing life with awe and gratitude [1:53:00]; and
    • More.

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    The Peter Attia Drive
    enAugust 26, 2024

    #314 ‒ Rethinking nutrition science: the evolving landscape of obesity treatment, GLP-1 agonists, protein, and the need for higher research standards | David Allison, Ph.D.

    #314 ‒ Rethinking nutrition science: the evolving landscape of obesity treatment, GLP-1 agonists, protein, and the need for higher research standards | David Allison, Ph.D.

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    David Allison, a leading expert in obesity and nutrition, quantitative genetics, clinical trials, and research methodology, returns to The Drive to explore the evolving landscape of nutrition science and obesity treatment. In this episode, David begins by discussing the intricate relationship between nutrition, obesity, and body composition, emphasizing the multifaceted impacts of food beyond mere calorie intake. David provides a critical analysis of the complexities in nutrition research and their practical implications for tackling obesity. He critiques historical public health policies, addresses the trust issues plaguing nutrition science, and underscores the need for a paradigm shift to more effectively combat obesity. The conversation also delves into the rise of GLP-1 receptor agonists like Ozempic and Mounjaro, exploring their ethical and practical considerations in obesity treatment. The episode concludes with an in-depth look at protein intake recommendations and highlights the significant research gaps that remain in the field.

    We discuss:

    • The complex relationship between nutrition, body weight, and body composition [2:30];
    • The slow progress in addressing obesity and public health despite substantial effort and investment [7:30];
    • The very limited success of public health initiatives in curbing obesity [17:15];
    • The evolving landscape of obesity research: public health initiatives and the impact of pharmacological success [26:30];
    • Rethinking obesity solutions: the need for a paradigm shift [32:45];
    • Understanding environmental triggers and embracing a balanced approach to addressing obesity that includes both pharmacological treatments and realistic lifestyle changes [41:45];
    • The need for higher standards in obesity research [51:45];
    • The rapid success of GLP-1 receptor agonists for weight loss: a discussion on the societal impact and controversy of their growing usage [1:02:15];
    • The ethical and practical considerations of obesity drugs: risks, benefits, and motivations for usage [1:11:30];
    • The use of GLP-1 agonists by athletes as performance enhancers [1:23:45];
    • Unanswered questions about protein intake and health [1:30:45];
    • Future research needed to understand basic questions around protein intake [1:45:00];
    • David’s weekly newsletter: “Obesity and Energetics Offerings” [1:50:45]; and
    • More.

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    The Peter Attia Drive
    enAugust 19, 2024

    #313 - AMA #62: Protein’s impact on appetite and weight management, and uric acid's link to disease and how to manage levels

    #313 - AMA #62: Protein’s impact on appetite and weight management, and uric acid's link to disease and how to manage levels

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    In this “Ask Me Anything” (AMA) episode, Peter dives into two important health topics: uric acid and protein, examining them from unique perspectives. For uric acid, he explores its metabolic role and connection to various diseases, focusing on the potential causal link with cardiovascular disease. He also discusses factors influencing uric acid levels, such as diet, genetics, and lifestyle, providing practical tips for effective management. Shifting to protein, Peter delves into its role in appetite and weight management, the consequences of insufficient protein, and the “protein leverage hypothesis” linking protein deficiency to obesity. He covers optimal protein intake and its impact on energy expenditure, and he compares the satiety effects of solid versus liquid protein. Finally, Peter shares his strategy for incorporating protein into a comprehensive weight management plan.

    If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #62 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

    We discuss:

    • Overview of episode topics (and an important discussion on fanny packs) [2:00];
    • Understanding uric acid: its role in metabolic processes, its association with gout and kidney stones, its impact on blood pressure, and more [6:00];
    • Non-modifiable factors that influence uric acid levels [11:00];
    • Modifiable factors that influence uric acid levels [14:15];
    • Association between high uric acid levels and cardiovascular disease [20:00];
    • Evidence suggesting a causal link between high uric acid levels and cardiovascular disease [24:00];
    • Inconclusive evidence about the cardiovascular benefits of lowering uric acid pharmacologically [28:15];
    • Exploring the potential risks of low uric acid levels in neurodegenerative diseases [37:00];
    • Managing uric acid levels: dietary interventions and pharmacological approaches [42:00];
    • The impact of protein on appetite and weight management [44:00];
    • The consequences of insufficient protein on eating behaviors and satiety [52:15];
    • The relationship between protein deficiency and obesity: exploring the “protein leverage hypothesis” [57:15];
    • The impact of protein intake on energy expenditure [1:02:15];
    • Determining optimal protein intake to avoid deficiency and support health [1:05:45];
    • The role of different amino acids and protein sources in promoting satiety [1:08:15];
    • Comparing the satiety effects of solid vs. liquid protein sources [1:10:30];
    • Peter’s framework for incorporating protein intake into a strategy for controlling body weight [1:12:00]; and
    • More.

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    The Peter Attia Drive
    enAugust 12, 2024

    #312 - A masterclass in lactate: Its critical role as metabolic fuel, implications for diseases, and therapeutic potential from cancer to brain health and beyond | George A. Brooks, Ph.D.

    #312 - A masterclass in lactate: Its critical role as metabolic fuel, implications for diseases, and therapeutic potential from cancer to brain health and beyond | George A. Brooks, Ph.D.

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    George A. Brooks is a renowned professor of integrative biology at UC Berkeley. Known for his groundbreaking "lactate shuttle" theory proposed in the 1980s, George revolutionized our understanding of lactate as a crucial fuel source rather than just a byproduct of exercise. In this episode, George clarifies common misconceptions between lactate and lactic acid, delves into historical perspectives, and explains how lactate serves as a fuel for the brain and muscles. He explores the metabolic differences in exceptional athletes and how training impacts lactate flux and utilization. Furthermore, George reveals the significance of lactate in type 2 diabetes, cancer, and brain injuries, highlighting its therapeutic potential. This in-depth conversation discusses everything from the fundamentals of metabolism to the latest research on lactate's role in gene expression and therapeutic applications.

    We discuss:

    • Our historical understanding of lactate and muscle metabolism: early misconceptions and key discoveries [3:30];
    • Fundamentals of metabolism: how glucose is metabolized to produce ATP and fuel our bodies [16:15];
    • The critical role of lactate in energy production within muscles [24:00];
    • Lactate as a preferred fuel during high-energy demands: impact on fat oxidation, implications for type 2 diabetes, and more [30:45];
    • How the infusion of lactate could aid recovery from traumatic brain injuries (TBI) [43:00];
    • The effects of exercise-induced lactate [49:30];
    • Metabolic differences between highly-trained athletes and insulin-resistant individuals [52:00];
    • How training enhances lactate utilization and facilitates lactate shuttling between fast-twitch and slow-twitch muscle fibers [58:45];
    • The growing recognition of lactate and monocarboxylate transporters (MCT) [1:06:00];
    • The intricate pathways of lactate metabolism: isotope tracer studies, how exceptional athletes are able to utilize more lactate, and more [1:09:00];
    • The role of lactate in cancer [1:23:15];
    • The role of lactate in the pathophysiology of various diseases, and how exercise could mitigate lactate's carcinogenic effects and support brain health [1:29:45];
    • George’s current research interests involving lactate [1:37:00];
    • Questions that remain about lactate: role in gene expression, therapeutic potential, difference between endogenous and exogenous lactate, and more [1:50:45]; and
    • More.

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    The Peter Attia Drive
    enAugust 05, 2024

    #311 ‒ Longevity 101: a foundational guide to Peter's frameworks for longevity, and understanding CVD, cancer, neurodegenerative disease, nutrition, exercise, sleep, and more

    #311 ‒ Longevity 101: a foundational guide to Peter's frameworks for longevity, and understanding CVD, cancer, neurodegenerative disease, nutrition, exercise, sleep, and more

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    In this special episode, Peter provides a comprehensive introduction to longevity, perfect for newcomers or those looking to refresh their knowledge. He lays out the foundational concepts of lifespan, healthspan, and the marginal decade. Additionally, Peter discusses the four main causes of death and their prevention, as well as detailing the five key strategies in his longevity toolkit to improve lifespan and healthspan. Detailed show notes provide links for deeper exploration of these topics, making it an ideal starting point for anyone interested in understanding and improving their longevity.

    We discuss:

    • Key points about starting exercise as an older adult [2:45];
    • Overview of episode topics and structure [1:45];
    • How Peter defines longevity [3:45];
    • Why healthspan is a crucial component of longevity [11:15];
    • The evolution of medicine from medicine 1.0 to 2.0, and the emergence of medicine 3.0 [15:30];
    • Overview of atherosclerotic diseases: the 3 pathways of ASCVD, preventative measures, and the impact of metabolic health [26:00];
    • Cancer: genetic and environmental factors, treatment options, and the importance of early and aggressive screening [33:15];
    • Neurodegenerative diseases: causes, prevention, and the role of genetics and metabolic health [39:30];
    • The spectrum of metabolic diseases [43:15];
    • Why it’s never too late to start thinking about longevity [44:15];
    • The 5 components of the longevity toolkit [46:30];
    • Peter’s framework for exercise—The Centenarian Decathlon [47:45];
    • Peter’s nutritional framework: energy balance, protein intake, and more [58:45];
    • Sleep: the vital role of sleep in longevity, and how to improve sleep habits [1:08:30];
    • Drugs and supplements: Peter’s framework for thinking about drugs and supplements as tools for enhancing longevity [1:13:30];
    • Why emotional health is a key component of longevity [1:17:00];
    • Advice for newcomers on where to start on their longevity journey [1:19:30]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enJuly 29, 2024

    #310 - The relationship between testosterone and prostate cancer, testosterone replacement therapy, and tools for predicting cancer aggressiveness and guiding therapy | Ted Schaeffer, M.D., Ph.D.

    #310 - The relationship between testosterone and prostate cancer, testosterone replacement therapy, and tools for predicting cancer aggressiveness and guiding therapy | Ted Schaeffer, M.D., Ph.D.

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    Ted Schaeffer is an internationally recognized urologist specializing in prostate cancer and a returning guest on The Drive. In this episode, Ted provides insights into the role testosterone plays, or doesn't play, in the initiation and progression of prostate cancer. He unpacks the findings and limitations of the recent TRAVERSE trial, exploring the complex relationship between testosterone and prostate cancer. Ted delves into the molecular nature of prostate cancer, explaining the androgen receptor saturation theory and the potential impact of testosterone on cancer growth. He also discusses the use of the Decipher test to predict cancer aggressiveness and guide targeted treatment. Furthermore, Ted shares how he counsels patients regarding testosterone replacement therapy (TRT), including its safe administration in patients with low-grade prostate cancer. Additionally, he highlights advancements in prostate cancer therapies and biomarkers that help develop precise treatment strategies while minimizing the need for broad androgen deprivation therapy.

    We discuss:

    • Background on the TRAVERSE trial: insights into exogenous testosterone and prostate cancer risk [3:00];
    • The androgen receptor saturation theory: how different organs respond to varying levels of testosterone [10:30];
    • The relationship between testosterone levels and prostate cancer aggressiveness: how aggressive prostate tumors have lower androgen receptor activity and rely on different growth mechanisms [16:15];
    • Using the Decipher score to assess prostate cancer aggressiveness and guide personalized treatment strategies [23:45];
    • Considerations for testosterone replacement therapy: how Ted counsels patients, how TRT can be safely administered in patients with low-grade prostate cancer, and more [31:15];
    • Advancements in prostate cancer therapies and PSA as a biomarker for precise treatment decisions, minimizing the need for broad androgen deprivation therapy [38:30]; and
    • More.

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    The Peter Attia Drive
    enJuly 22, 2024

    #309 ‒ AI in medicine: its potential to revolutionize disease prediction, diagnosis, and outcomes, causes for concern in medicine and beyond, and more | Isaac Kohane, M.D., Ph.D.

    #309 ‒ AI in medicine: its potential to revolutionize disease prediction, diagnosis, and outcomes, causes for concern in medicine and beyond, and more | Isaac Kohane, M.D., Ph.D.

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    Isaac "Zak" Kohane, a pioneering physician-scientist and chair of the Department of Biomedical Informatics at Harvard Medical School, has authored numerous papers and influential books on artificial intelligence (AI), including The AI Revolution in Medicine: GPT-4 and Beyond. In this episode, Zak explores the evolution of AI, from its early iterations to the current third generation, illuminating how it is transforming medicine today and unlocking astonishing possibilities for the future. He shares insights from his unconventional journey and early interactions with GPT-4, highlighting significant AI advancements in image-based medical specialties, early disease diagnosis, and the potential for autonomous robotic surgery. He also delves into the ethical concerns and regulatory challenges of AI, its potential to augment clinicians, and the broader implications of AI achieving human-like creativity and expertise.

    We discuss:

    • Zak’s unconventional journey to becoming a pioneering physician-scientist, and his early interactions with GPT-4 [2:15];
    • The evolution of AI from the earliest versions to today’s neural networks, and the shifting definitions of intelligence over time [8:00];
    • How vast data sets, advanced neural networks, and powerful GPU technology have driven AI from its early limitations to achieving remarkable successes in medicine and other fields [19:00];
    • An AI breakthrough in medicine: the ability to accurately recognize retinopathy [29:00];
    • Third generation AI: how improvements in natural language processing significantly advanced AI capabilities [32:00];
    • AI concerns and regulation: misuse by individuals, military applications, displacement of jobs, and potential existential concerns [37:30];
    • How AI is enhancing image-based medical specialties like radiology [49:15];
    • The use of AI by patients and doctors [55:45];
    • The potential for AI to augment clinicians and address physician shortages [1:02:45];
    • The potential for AI to revolutionize early diagnosis and prediction of diseases: Alzheimer’s disease, CVD, autism, and more [1:08:00];
    • The future of AI in healthcare: integration of patient data, improved diagnostics, and the challenges of data accessibility and regulatory compliance [1:17:00];
    • The future of autonomous robotic surgery [1:25:00];
    • AI and the future of mental health care [1:31:30];
    • How AI may transform and disrupt the medical industry: new business models and potential resistance from established medical institutions [1:34:45];
    • Potential positive and negative impacts of AI outside of medicine over the next decade [1:38:30];
    • The implications of AI achieving a level of creativity and expertise comparable to exceptional human talents [1:42:00];
    • Digital immortality and legacy: the potential to emulate an individual's personality and responses and the ethical questions surrounding it [1:45:45];
    • Parting thoughts [1:50:15]; and
    • More.

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    The Peter Attia Drive
    enJuly 15, 2024

    Zone 2 training: impact on longevity and mitochondrial function, how to dose frequency and duration, and more | Iñigo San-Millán, Ph.D. (#201 rebroadcast)

    Zone 2 training: impact on longevity and mitochondrial function, how to dose frequency and duration, and more | Iñigo San-Millán, Ph.D. (#201 rebroadcast)

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    Iñigo San-Millán is an internationally renowned applied physiologist and a previous guest on The Drive. His research and clinical work focuses on exercise-related metabolism, metabolic health, diabetes, cancer metabolism, nutrition, sports performance, and critical care. In this episode, Iñigo describes how his work with Tour de France winner Tadej Pogačar has provided insights into the amazing potential of elite athletes from a performance and metabolic perspective. He speaks specifically about lactate levels, fat oxidation, how carbohydrates in food can affect our lactate and how equal lactate outputs between an athlete and a metabolically unhealthy individual can mean different things. Next, he discusses how Zone 2 training boosts mitochondrial function and impacts longevity. He explains the different metrics for assessing one’s Zone 2 threshold and describes the optimal dose, frequency, duration, and type of exercise for Zone 2. Additionally, he offers his thoughts on how to incorporate high intensity training (Zone 5) to optimize health, as well as the potential of metformin and NAD to boost mitochondrial health. Finally, he discusses insights he’s gathered from studying the mitochondria of long COVID patients in the ICU.

    We discuss:

    • The amazing potential of cyclist Tadej Pogačar [2:00];
    • Metrics for assessing athletic performance in cyclists and how that impacts race strategy [7:30];
    • The impact of performance-enhancing drugs and the potential for transparency into athletes’ data during competition [16:15];
    • Tadej Pogačar’s race strategy and mindset at the Tour de France [23:15];
    • Defining Zone 2, fat oxidation, and how they are measured [26:00];
    • Using fat and carbohydrate utilization to calculate the mitochondrial function and metabolic flexibility [35:00];
    • Lactate levels and fat oxidation as it relates to Zone 2 exercise [39:15];
    • How moderately active individuals should train to improve metabolic function and maximize mitochondrial performance [51:00];
    • Bioenergetics of the cell and what is different in elite athletes [56:30];
    • How the level of carbohydrate in the diet and ketogenic diets affects fuel utilization and power output during exercise [1:07:45];
    • Glutamine as a source for making glycogen—insights from studying the altered metabolism of ICU patients [1:14:15];
    • How exercise mobilizes glucose transporters—an important factor in diabetic patients [1:20:15];
    • Metrics for finding Zone 2 threshold—lactate, heart rate, and more [1:24:00];
    • Optimal Zone 2 training: dose, frequency, duration, and type of exercise [1:40:30];
    • How to incorporate high intensity training (Zone 5) to increase VO2 max and optimize fitness [1:50:30];
    • Compounding benefits of Zone 2 exercise and how we can improve metabolic health into old age [2:01:00];
    • The effects of metformin, NAD, and supplements on mitochondrial function [2:04:30];
    • The role of lactate and exercise in cancer [2:12:45];
    • How assessing metabolic parameters in long COVID patients provides insights into this disease [2:18:30];
    • The advantages of using cellular surrogates of metabolism instead of VO2 max for prescribing exercise [2:25:00];
    • Metabolomics reveals how cellular metabolism is altered in sedentary individuals [2:33:00];
    • Cellular changes in the metabolism of people with diabetes and metabolic syndrome [2:38:30]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enJuly 08, 2024

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    Why FOMO Keeps You Drinking More Than You Want To

    Why FOMO Keeps You Drinking More Than You Want To

    Buy Breaking the Bottle Legacy: How to Change Your Drinking Habits and Create A Peaceful Relationship with Alcohol on Amazon. 

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    Have you grabbed your free e-book, "Alcohol Truths: How Much is Safe?" Get it here. 

    Low risk drinking guidelines from the NIAAA:

    Healthy men under 65:

    No more than 4 drinks in one day and no more than 14 drinks per week.

    Healthy women (all ages) and healthy men 65 and older: No more than 3 drinks in one day and no more than 7 drinks per week.

    One drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor. So remember that a mixed drink or full glass of wine are probably more than one drink.

    Abstinence from alcohol Abstinence from alcohol is the best choice for people who take medication(s) that interact with alcohol, have health conditions that could be exacerbated by alcohol (e.g. liver disease), are pregnant or may become pregnant or have had a problem with alcohol or another substance in the past.

    Benefits of “low-risk” drinking Following these guidelines reduces the risk of health problems such as cancer, liver disease, reduced immunity, ulcers, sleep problems, complications of existing conditions, and more. It also reduces the risk of depression, social problems, and difficulties at school or work.

    This week on the podcast I'm talking about FOMO and why it keeps us drinking more than we want to. 

    When I use the acronym FOMO what do you think of? 

     

    Do you think of comparing yourself to others?  Definitely this is the genesis of FOMO and even though it’s become a trendy, Meme-producing word these days it’s actually nothing new. 

    I actually explain it in my book, here’s what I said: “ The fear about what other people think is actually rooted in another survival instinct in our primitive brains. Our primitive brains evolved to associate our emotions with necessary actions for the survival of our species. Generally speaking this means avoiding pain and seeking pleasure. For our archaic ancestors, the Neanderthals, being a member of the tribe was literally a matter of life or death and as humans evolved we have become more socially connected.

     "Mammals are more socially connected than reptiles, primates

    more than other mammals, and humans more than other

    primates. What this suggests is that becoming more socially

    connected is essential to our survival. In a sense, evolution has

    made bets at each step that the best way to make us more

    successful is to make us more social."  

    Here’s the thing...we’re no longer living in a primitive world right, so living in a tribe isn’t necessary for day-to-day life over death. But that doesn’t mean being connected to people isn’t still important and necessary for humans...Unfortunately we’ve swung like a pendulum in the other direction with FOMO. 

    Our obsession and non-stop consumption of social media has created an unrealistic scale.

    To Combat FOMO you need to think in complete thoughts, rather than incomplete thoughts. Challenge yourself to tell the WHOLE truth  instead of continuing to talk yourself into incomplete truths that feel good for a moment.

    FOMO is fueled by a perspective of scarcity. You come into a situation choosing to think that what you have right now isn’t enough. You associate loss with not getting more. You convince yourself that it isn’t enough to enjoy a night out with your friends. You need drinks, you need alcohol to make it better. 

    When you don’t redirect your thinking and you don’t challenge your FOMO thoughts...it leads to feelings that aren’t going to help you take the actions that will create the results you want in your life. You will keep doing what you’re doing and not changing because your thoughts are fueling the feelings of desire as well as the feeling of anticipated deprivation of not drinking.

    ★ Support this podcast ★