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    #20 - Thomas Dayspring, M.D., FACP, FNLA – Part I of V: an introduction to lipidology

    enOctober 15, 2018
    What is Tom Dayspring's role at True Health Diagnostics?
    How has cardiac care changed over the years according to Dayspring?
    What factors does Dayspring suggest for preventing cardiovascular disease?
    Why are phospholipids important for high-density lipoproteins (HDL)?
    How does phospholipid composition affect cell membrane functionality?

    Podcast Summary

    • Tom Dayspring - A Leading Figure in Clinical LipidologyThomas Dayspring's vast knowledge and experience in clinical lipidology make him a valuable resource for anyone looking to learn about lipids and cholesterol.

      Tom Dayspring is an incredibly knowledgeable and respected figure in the field of clinical lipidology. With his vast experience and expertise, he has become a go-to resource for lipidologists and cardiologists alike. Through his role as the chief academic officer for True Health Diagnostics and his extensive lecturing and writing, Tom has made significant contributions to the understanding of lipids and cholesterol. Despite his rough around the edges demeanor, it is clear that he is truly passionate about his work and dedicated to teaching others. Peter Attia, who has benefitted greatly from Tom's mentorship, describes him as a national treasure. Whether you are a lipid fellowship student or a primary care physician, there is immense value to be gained from learning from Tom Dayspring.

    • The Power of Positive Lifestyle ChangesMaking conscious choices about diet and exercise can lead to significant improvements in overall health and well-being, as demonstrated by Thomas Dayspring's physical transformation and reduction in health issues. Embracing a healthier lifestyle can bring transformative results and enhance quality of life.

      Making positive lifestyle changes can have a significant impact on overall health and well-being. Thomas Dayspring's physical transformation after following Peter Attia's nutritional advice, including intermittent fasting and carb restriction, is a testament to the power of making conscious choices about diet and exercise. Not only did Thomas lose weight, but he also experienced a reduction in various health issues, such as joint pain and mobility limitations. This highlights the importance of taking proactive steps towards improving our health, even if we have prior excuses or resistance to change. By embracing a healthier lifestyle, we can experience transformative results and enhance our quality of life.

    • Thomas's Health Transformation Through Fasting and CommitmentFasting, when combined with dedication and guidance, can lead to significant improvements in health and overall well-being.

      Fasting, combined with other interventions, has had a significant impact on Thomas's health. Through rigorous testing and monitoring, Thomas's lab reports have transitioned from being in the red and yellow zones to now being 100% green, indicating optimal levels. Not only does Thomas feel better physically, but there have been positive changes in his biochemistry as well, particularly in the reduction of certain markers. Despite initial skepticism, Thomas took the plunge into modified fasting and worked closely with a dietitian to adhere to the strict dietary restrictions. His motivation was fueled by the desire to avoid further health complications and to improve his overall well-being. This conversation highlights the potential benefits of fasting and demonstrates the importance of personal commitment to achieving positive health outcomes.

    • The Benefits of Fasting for Overall Health and WellnessFasting can lead to weight loss, improved biomarkers, and the reduction of symptoms. It is an effective tool for promoting metabolic health and has scientific plausibility and evolutionary benefits.

      Fasting, particularly caloric restriction, can have significant benefits on overall health and wellness. Despite initial doubts about his ability to go without food for extended periods, Thomas Dayspring found motivation to try it based on the potential impact on his metabolic pathways and morbidities. With support from his wife and guidance on meal preparation, he successfully completed multiple 5-day fasts and experienced remarkable results. The weight melted off, biomarkers improved, and symptoms disappeared. Peter Attia reinforces the importance of fasting as a powerful tool for depleting glycogen, reducing insulin, and promoting overall metabolic health. The scientific plausibility and evolutionary rationale behind fasting further validate its effectiveness.

    • Passion and Dedication: The Story of Thomas Dayspring's Historic Firefighting WebsitePursuing our passions with dedication and effort can result in significant contributions and leave a lasting impact, regardless of initial skepticism or labeling.

      Passion and dedication can lead to incredible achievements. Thomas Dayspring's obsession with firefighting, stemming from his father's profession, led him to create one of the most viewed historical firefighting websites in the United States. His collection of thousands of pages and photographs showcases the rich history of firefighting in Patterson, New Jersey. Despite being labeled a "nut job" by Peter Attia, Dayspring's passion and commitment earned him recognition and respect, even from the fire department itself. This story shows that when we pursue our passions wholeheartedly and put in the necessary effort, we can make significant contributions in our chosen field, leaving a lasting impact.

    • Uncovering a Forgotten HeroFollowing our passions and pursuing what we believe in can lead to unexpected rewards and recognition, as demonstrated by Thomas Dayspring's dedication to preserving the memory of a fallen firefighter.

      Sometimes, the impact of our actions goes far beyond what we can imagine. Thomas Dayspring's passion for firefighting and his dedication to uncovering the forgotten history of a fallen firefighter led to a significant recognition. By presenting his findings to the department, he ensured that Edward Moore's name was added to the memorial monument. This act of preserving the memory of a firefighter lost in the line of duty not only honored Edward Moore, but it also brought Thomas unexpected recognition. The department awarded him the highest honor a professional fire department can give to a civilian – making him an honorary battalion chief. This story reminds us that following our passions and pursuing what we believe in can lead to unexpected rewards and recognition.

    • Unexpected Influences and Profound MomentsThe impact of certain people and experiences can be profound and unexpected, reminding us that meaningful connections and transformative moments can arise unexpectedly in our lives.

      The impact of certain people and experiences on our lives can be profound and unexpected. Thomas Dayspring shares how Sister Loretta, a nun at the hospital where he trained as a firefighter, had a significant influence on him and the entire fire department. Her care for patients and firefighters earned her the honorary title of battalion chief. This connection between Thomas and Sister Loretta is cherished, and he keeps a memento of her on his desk at home. Additionally, the conversation highlights how Thomas had a transformative moment with hockey, despite growing up in New Jersey without much exposure to the sport. Attending a game at Madison Square Garden ignited his love for hockey instantly. These instances remind us that sometimes, the most profound impacts on our lives come unexpectedly.

    • Hockey: A Lifelong Passion and Bonding ExperienceThe love for hockey blossomed as Thomas and Peter immersed themselves in the sport, creating lasting memories, friendships, and a lifelong passion for the game.

      Hockey played a significant role in both Thomas Dayspring's and Peter Attia's lives. Thomas's love for the sport started when he decided to follow it, bought skates, and taught himself how to ice skate and play hockey. He eventually convinced friends to join him, rented ice time, and became a skilled player. Hockey became a lifelong passion for Thomas, and he continued to play until he was fifty years old. Additionally, Thomas's son also became an exceptional hockey player, something that Thomas takes pride in. Similarly, Peter grew up watching hockey and fell in love with the sport, cheering for the Edmonton Oilers. Both men have fond memories of attending games with their fathers and bonding over the sport. Hockey created lasting friendships and connections for both of them.

    • The Impact of Childhood Hockey Games on Two Medical ProfessionalsChildhood experiences at sporting events can create treasured memories and have a lasting impression, while also recognizing the seriousness of certain health conditions.

      Attending live hockey games as a kid was a special, memorable experience. Peter Attia and Thomas Dayspring reminisced about their excitement sitting in different seats, getting close to the action, and admiring the talented players on the ice. They talked about the joy of sneaking into better seats and how things were different back then with ticket scanning not being as strict. Both speakers recognized the thrilling nature of hockey and the impact it had on them as children. They also acknowledged the seriousness of atherosclerotic heart disease, which they encountered through their medical professions. Overall, the key takeaway is that childhood experiences at sporting events can leave a lasting impression and create treasured memories.

    • The changing landscape of cardiovascular disease and the importance of prevention.Advancements in cardiac care have led to a decrease in acute presentations of cardiovascular disease, emphasizing the need for prevention measures such as managing hypertension, quitting smoking, and maintaining a healthy weight.

      There has been a significant shift in the landscape of cardiovascular disease, particularly in the occurrence and treatment of acute coronary syndromes. The speaker, Thomas Dayspring, reminisces about a time when he witnessed numerous cases of acute heart attacks, with patients experiencing severe symptoms such as pulmonary edema and transmural MIs. However, this type of acute presentation has become less common in contemporary medicine due to advancements in cardiac care, such as early intervention in the cath lab to dissolve clots. Dayspring emphasizes the importance of prevention in addressing cardiovascular disease, urging individuals to focus on factors such as hypertension, smoking cessation, and weight management. The conversation reveals the changing face of cardiology and the need for ongoing prevention efforts in eliminating this disease.

    • The importance of education in understanding lipids and their impact on healthContinuous reading and research are crucial to fully comprehend the complexities of lipidology and navigate the world of lipids, with accessible resources now available thanks to experts like Thomas Dayspring.

      Education is key when it comes to understanding lipids and their impact on health. Thomas Dayspring, a lipid expert, emphasized the importance of constant reading and research in order to fully comprehend the complexities of lipidology. He mentioned several influential figures in the field, who were ahead of their time and contributed significantly to lipid investigations. Dayspring himself played a role in providing valuable resources, such as documents and presentations, which sparked the interest of individuals like Peter Attia. Attia stressed the role that Dayspring's work played in introducing him to important concepts, even though it initially seemed overwhelming and confusing. Today, thanks to experts like Dayspring, there are more accessible resources available to help individuals understand and navigate the world of lipids.

    • The Power of Visual Learning and IllustrationIncorporating visual aids in education and communication enhances understanding and leaves a lasting impression.

      The power of visual learning and illustration cannot be underestimated. Thomas Dayspring, a renowned lipid educator, credits his success to his ability to illustrate complex concepts using graphics and diagrams. By visually representing information, he was able to make it easier for both laypeople and healthcare professionals to understand advanced lipid-related topics. Dayspring's illustrations not only enhanced comprehension but also made the learning experience more engaging and memorable. Furthermore, his expertise in utilizing PowerPoint tools allowed him to create intricate figures that even seasoned PowerPoint users found challenging. This story emphasizes the importance of incorporating visual aids in education and communication to enhance understanding and leave a lasting impression.

    • The Evolution of Lipidology: Continuous Learning and AdaptationLipidology is a constantly evolving field, requiring continuous learning and adaptation. Previous beliefs may not hold true today, emphasizing the importance of staying updated and understanding lipid properties.

      The field of lipidology has evolved significantly over the years. Thomas Dayspring, a prominent figure in the National Lipid Association, gained recognition for his contributions to lipidology through his innovative teaching methods and popular newsletter, "Lipidaholics Anonymous." However, he acknowledges that the information shared in the past may not hold true today. One example given is the belief that elevated levels of HDL cholesterol are always beneficial for cardiovascular health, which is now considered an oversimplification. Moreover, the discussion highlights the importance of understanding the nature of lipids and their solubility properties in water. Overall, this conversation emphasizes the ongoing evolution of knowledge in lipidology and the need for continuous learning and adaptation in the field.

    • The role of lipids in the human bodyLipids, including cholesterol and phospholipids, are important for various functions in the body, but excessive intake or production of cholesterol can have negative health effects. Understanding cholesterol elimination is essential for overall well-being.

      Lipids, particularly cholesterol and phospholipids, play a crucial role in the human body. Lipids are made up of fatty acids that can bind to carbohydrates and form different compounds such as monoesalglycerol, diacylglycerol, and triacylglycerol (triglyceride). Phospholipids, which contain a head group with a phosphorous moiety, are especially important and can exist in both hydrophobic and hydrophilic environments. They are found in lipoproteins and cell membranes throughout the body. It is worth noting that lipoproteins not only deliver cholesterol, but every cell has the capacity to produce cholesterol for its own needs. The issue arises when excessive cholesterol is ingested or produced, leading to harmful health effects. Understanding how cells eliminate excess cholesterol is crucial for overall health.

    • Understanding the Structure and Transport of Different Types of FatsThe structure of fats, including the number and position of double bonds, determines their name and properties. Lipoproteins play a crucial role in transporting fats, cholesterol, and phospholipids throughout the body.

      Different types of fats have varying structures and properties. Saturated fats have no double bonds, monounsaturated fats have one double bond, and polyunsaturated fats have two or more double bonds. The length of the hydrocarbon chain and the position of the double bonds determine the specific name of the fat. While fats are not soluble in water, they can be transported through the bloodstream on albumin, a protein found in plasma. However, cholesterol, which is hydrophobic like fats, cannot be transported in the same way. The main purpose of lipoproteins, the transportation system for lipids, is to deliver energy to tissues in the form of triglycerides and fatty acids. Additionally, lipoproteins also transport phospholipids, which are essential for cell structure. Chylomicrons and very low density lipoproteins (VLDL) have a large surface area, allowing them to carry a significant amount of phospholipids.

    • The Role of Phospholipids in Lipoproteins and Cellular InteractionsPhospholipids in lipoproteins are essential for their function, including the transport of lipids in the bloodstream and the structure of cell membranes. The composition of phospholipids affects protein expression and receptor localization. Analyzing lipidomes and phospholipid composition helps understand the impact of lipoproteins in the body.

      The phospholipids found in lipoproteins play a crucial role in their function and overall cellular interactions. Phospholipids are necessary for the maturation of high-density lipoproteins (HDL) and are responsible for their ability to transport lipids in the bloodstream. The composition of phospholipids, particularly the fatty acid makeup, affects the structure and fluidity of cell membranes. This, in turn, determines the localization and expression of specific cellular proteins and receptors. Furthermore, the functionality of HDL particles is heavily influenced by the fatty acid makeup of their phospholipids. As our understanding of lipoproteins and membrane physiology advances, the analysis of lipidomes and phospholipid composition will provide valuable insights into the role and impact of lipoproteins in the body.

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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.

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    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

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