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    #269 - Good vs. bad science: how to read and understand scientific studies

    Proper randomization, differentiation between true randomization and cluster randomization, and careful planning and analysis are essential for accurate and reliable results in randomized controlled trials.

    enSeptember 04, 2023

    About this Episode

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    This special episode is a rebroadcast of AMA #30, now made available to everyone, in which Peter and Bob Kaplan dive deep into all things related to studying studies to help one sift through the noise to find the signal. They define various types of studies, how a study progresses from idea to execution, and how to identify study strengths and limitations. They explain how clinical trials work, as well as biases and common pitfalls to watch out for. They dig into key factors that contribute to the rigor (or lack thereof) of an experiment, and they discuss how to measure effect size, differentiate relative risk from absolute risk, and what it really means when a study is statistically significant. Finally, Peter lays out his personal process when reading through scientific papers.

    We discuss:

    • The ever-changing landscape of scientific literature [2:30];
    • The process for a study to progress from idea to design to execution [5:00];
    • Various types of studies and how they differ [8:00];
    • The different phases of clinical trials [19:45];
    • Observational studies and the potential for bias [27:00];
    • Experimental studies: randomization, blinding, and other factors that make or break a study [44:30];
    • Power, p-values, and statistical significance [56:45];
    • Measuring effect size: relative risk vs. absolute risk, hazard ratios, and “number needed to treat” [1:08:15];
    • How to interpret confidence intervals [1:18:00];
    • Why a study might be stopped before its completion [1:24:00];
    • Why only a fraction of studies are ever published and how to combat publication bias [1:32:00];
    • Frequency of training for Olympic weightlifting [1:22:15];
    • How post-activation potentiation (and the opposite) can improve power training and speed training [1:24:30];
    • The Strongman competition: more breadth of movement, strength, and stamina [1:32:00];
    • Why certain journals are more respected than others [1:41:00];
    • Peter’s process when reading a scientific paper [1:44:15]; and
    • More.

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    🔑 Key Takeaways

    • Developing critical thinking skills and understanding the research process allows individuals without scientific backgrounds to accurately interpret and understand scientific studies.
    • Conducting an experimental study involves formulating hypotheses, designing the experiment, determining variables, obtaining approvals, defining outcomes, developing a statistical plan, and securing funding.
    • Different types of studies, from individual case reports to randomized controlled trials, offer valuable insights into medical conditions and treatment options, each contributing to our understanding in their own unique ways.
    • While meta analysis can be a powerful tool, it is crucial to evaluate the quality and rigor of the individual studies included in it to determine the reliability of its findings.
    • Drug testing in humans involves several phases, starting with safety and tolerability evaluation in phase 1 and progressing to rigorous assessments of both safety and efficacy in phase 3.
    • Rigorous clinical trials are essential for making informed healthcare decisions, as they provide reliable results on the effectiveness and safety of new drugs, unlike observational studies with limitations.
    • Nutritional epidemiology is hindered by recall bias and unreliable data, making it important to approach studies in this field with caution and skepticism.
    • Food frequency questionnaires may not accurately reflect dietary habits and researchers should consider the potential impact of observation on behavior when designing studies.
    • Performance bias and multiple hypothesis testing can lead to misleading results in clinical trials, emphasizing the importance of minimizing these biases for accurate findings.
    • When analyzing data, remember to apply the Bonferroni correction to account for multiple looks at the data, address confounding variables in observational studies, and ensure rigorous randomization in experimental studies for accurate results.
    • Proper randomization, differentiation between true randomization and cluster randomization, and careful planning and analysis are essential for accurate and reliable results in randomized controlled trials.
    • When conducting studies and trials, consider the order of treatments, the importance of blinding, the impact of study population heterogeneity, the clinical significance of outcomes, and potential conflicts of interest.
    • Balancing the significance threshold to minimize false positives and false negatives is crucial in statistical analysis, ensuring accurate interpretation of research findings.
    • Power is the ability of a study to detect a true effect. By analyzing a power table, researchers can determine the sample size needed for statistically significant results, avoiding underpowering or overpowered studies. Consider power to ensure valid and relevant findings.
    • Adequate power in a study is crucial for detecting differences between groups, and understanding both relative and absolute risk is essential for fully understanding the implications of a study.
    • Understanding hazard ratios and absolute risk reduction is important for analyzing clinical trials and making informed decisions about the effectiveness, side effects, and costs of treatments.
    • NNT measures the impact of a drug, with a lower number indicating a more significant effect. Confidence intervals provide insight into study results, helping healthcare professionals make informed treatment decisions.
    • When interpreting studies, consider the confidence intervals to evaluate reliability. Don't rely solely on media for science information; critical thinking and understanding statistical concepts are crucial. Studies may be stopped for various reasons.
    • Patient safety should always be the top priority in clinical trials, even if it means stopping the study early.
    • Thorough research, analysis, and rigorous evaluation are crucial in pharmaceutical development to ensure effectiveness, safety, and credibility of drugs before market release.
    • Preregistration of experiments can help mitigate publication bias by ensuring that all studies, regardless of their results, are published, thus promoting unbiased decision-making and advancing scientific knowledge.
    • Registered reports enhance scientific rigor by promoting the publication of negative or neutral results, encouraging peer review of study design, and considering the impact factor when evaluating journal reputation.
    • Evaluating scientific papers involves assessing the abstract, study design, results, and discussion sections. Mentorship emphasizes early creation of figures and tables in the research process.
    • Understanding and effectively presenting relevant figures and tables is essential for a successful paper. Providing valuable content and engaging with members through premium benefits helps create a supportive community. Medical advice should be sought from professionals.

    📝 Podcast Summary

    The importance of critical thinking and understanding the research process in comprehending scientific studies.

    Understanding scientific studies requires a clear understanding of the research process and critical thinking skills. The process of conducting a study involves formulating a hypothesis, creating a design, and executing the study. Good science is hypothesis-driven and involves testing the null hypothesis, which assumes no relationship between phenomena. It is essential to distinguish between the null and alternative hypothesis to interpret study findings accurately. Additionally, readers must be aware of the limitations and strengths of different types of studies and ask relevant questions to assess their rigor. In today's age of contradictory findings, it is crucial to approach research with skepticism and evaluate the quality of evidence presented in news or publications. Developing these skills will enable individuals with no scientific background to better understand and interpret scientific studies.

    Steps in Conducting an Experimental Study

    Conducting an experimental study involves several important steps. Firstly, formulating a null hypothesis and an alternative hypothesis is crucial. Secondly, designing the experiment, including determining variables such as duration and frequency of coffee consumption and deciding on the measurement of eye color. Additionally, determining the number of subjects and conducting a power analysis are necessary. It is also essential to obtain institutional review board approval if the study involves human or animal subjects. Other steps include defining primary and secondary outcomes, getting protocol approval, developing a statistical plan, and pre-registering the study. Lastly, securing funding is crucial. There are different types of studies, such as observational studies, experimental studies, and summations or analysis of studies.

    Different Types of Studies in Research and Healthcare

    Different types of studies serve different purposes in the field of research and healthcare. Individual case reports are valuable for generating hypotheses and highlighting interesting observations, although they may not be generalizable to a larger population. Case series expand on this by examining multiple patients with similar findings and can provide more evidence for hypothesis generation. Cohort studies, whether retrospective or prospective, offer a larger sample size and focus on observing patterns and associations, but do not involve any interventions. Finally, experimental studies, particularly randomized controlled trials, are considered the gold standard for research as they aim to minimize bias by randomly assigning participants to different treatment groups. Each type of study contributes to our understanding of medical conditions and treatment options in their own unique ways.

    The importance of scrutinizing individual studies within a meta analysis

    Meta analysis can be a powerful tool in combining data from multiple studies to examine the same question. However, it is important to not blindly trust a meta analysis without scrutinizing each individual study that it includes. The quality and rigor of the constituent studies are crucial in determining the reliability of the meta analysis. Even though meta analysis is often considered the top of the pyramid in terms of evidence, a single well-designed and rigorous randomized controlled trial can still hold more weight and reliability than a poorly constructed meta analysis. Therefore, it is essential to thoroughly evaluate the individual studies within a meta analysis to ensure the validity of its findings. Additionally, the conversation briefly mentions the different phases of clinical trials, with phase 3 trials typically being the final stage before a treatment is approved for use.

    Phases of drug testing in humans

    The process of testing new drugs in humans involves several phases, starting with an investigational new drug application (IND) filed with the FDA. Phase 1 focuses on dose escalation and determines the safety and tolerability of the drug in a small group of patients. Phase 2 aims to evaluate safety further and looks for initial signs of efficacy in an open-label fashion. Sometimes, comparisons to the natural history of the disease are made. If the drug successfully passes phase 2, it moves on to phase 3, which is a rigorous trial that thoroughly assesses both safety and efficacy. It is crucial to have both safety and efficacy demonstrated before proceeding to the next phase of testing.

    The Importance of Large-Scale Clinical Trials in Determining Drug Effectiveness and Safety

    Conducting large-scale clinical trials, known as phase 3 and post-marketing studies, is crucial to determine the effectiveness and safety of new drugs. These studies involve thousands of patients and often compare standard of care treatment with a new agent. They are conducted in a randomized and blinded manner to ensure reliable results. Phase 4 studies are conducted after drug approval to gather additional information on the drug's efficacy and potential side effects, as well as explore new indications for its use. Observational studies, on the other hand, have limitations due to factors like selection bias and healthy user bias, making it challenging to draw definitive conclusions. Therefore, it is important to rely on rigorous clinical trials to make informed healthcare decisions.

    Limitations and Flaws of Nutritional Epidemiology

    Nutritional epidemiology, particularly when it comes to recall bias and food frequency questionnaires, is highly flawed. The reliance on people's ability to accurately recall and report their food consumption over extended periods of time leads to unreliable data. The limitations of this method become even more apparent when compared to the advanced tools and technologies used in other scientific fields. The lack of frequency and specificity in these questionnaires further compounds the problem and hinders the accurate assessment of dietary habits. Therefore, it is crucial to approach studies and findings based on nutritional epidemiology with caution and skepticism, as they may not provide a truly accurate representation of the relationship between diet and health.

    The limitations of food frequency questionnaires and the influence of observation on behavior in research studies.

    Food frequency questionnaires should be abandoned in research studies. Peter Attia argues that recall is only reliable for profound events like childbirth, not for general dietary habits. Additionally, he questions the validity of inferring causality from recall data due to other factors at play. He criticizes the overemphasis on epidemiology in research, suggesting that its value has been overstated. The conversation also highlights the Hawthorne effect, which states that behavior changes when someone is being observed. This phenomenon can affect study outcomes, particularly in open label trials where competitiveness and performance can be influenced by awareness of observation. Furthermore, the discussion mentions the impact of having someone watch your eating habits, whether physically or virtually. Overall, the accuracy of recall data and the influence of observation on behavior are important considerations in research design.

    The impact of performance bias and multiple hypothesis testing on clinical trial results.

    Performance bias and multiple hypothesis testing can significantly impact the results of clinical trials. In the example given, the group following the potato diet achieved better weight loss outcomes compared to the calorie restricted group. However, this difference can be attributed to the fact that the potato diet group received more attention, coaching, and positive behavioral influence. Such performance bias can create misleading results in randomized controlled trials, particularly in lifestyle-based studies. Additionally, multiple hypothesis testing can lead to false positives when researchers analyze the data from different angles or conduct multiple tests. It is crucial for researchers to be aware of these biases and design trials that minimize them to ensure accurate and reliable findings.

    Considerations in Data Analysis: Bonferroni Correction, Confounding Variables, and Randomization in Experimental Studies

    When analyzing data, it is important to consider the Bonferroni correction factor to account for multiple looks at the data. This correction factor requires dividing the p value by the number of times the data has been examined, raising the bar for what is considered statistically significant. Additionally, confounding variables, such as age, sex, and smoking, must be addressed in observational studies to mimic the randomization of experiments. However, it is nearly impossible to identify and eliminate all confounders. When evaluating experimental studies, randomization is crucial, and it should be done rigorously to ensure accurate results. A famous example, the Predimed study, was reanalyzed and raised concerns about improper randomization, highlighting the importance of critically examining studies to understand the full story.

    Understanding the Challenges of Randomized Controlled Trials

    Designing and conducting randomized controlled trials (RCTs) can be challenging, especially when it comes to the randomization process and control groups. The conversation highlights the importance of differentiating between true randomization and cluster randomization, as well as the need for different statistical adjustments in each case. It also emphasizes the difficulties in implementing a crossover design, where participants serve as their own controls. While this design reduces the number of subjects required and can be cost-effective, it poses challenges in terms of treatment order and potential lingering effects. Ultimately, the discussion underscores the complexity of RCTs and the importance of careful planning and analysis to ensure accurate and reliable results.

    Factors to Consider in Scientific Studies and Clinical Trials

    When conducting scientific studies and clinical trials, it is crucial to consider several factors. First, the order in which treatments are given can have an impact on the results, with the suggestion being that going from treatment A to B and then from B to A is more effective. Secondly, blinding, whether single or double, is essential to minimize biases and ensure unbiased results. However, blinding can pose challenges, especially in studies involving psychedelics. Furthermore, the study population's heterogeneity affects the generalizability of the findings, and larger studies conducted across multiple sites can bring in more diversity but also introduce potential biases from rogue sites. Additionally, the clinical significance of study outcomes should be taken into account, not just statistical significance. Finally, researchers should be aware of funding sources and potential conflicts of interest that may impact the trial's transparency and reliability.

    Understanding statistical power and interpreting p values for research findings.

    Understanding statistical power and interpreting p values are crucial in interpreting research findings. Power, defined as 1 minus beta, refers to the probability of correctly detecting a true effect or avoiding a false negative. On the other hand, a false positive is represented by the p value (alpha), which indicates the likelihood of observing an effect by chance. It is important to aim for low p values, preferably less than 0.05, to increase confidence in rejecting the null hypothesis. However, setting the p value threshold too low can lead to the risk of discarding relevant information and encountering false negatives. Achieving a balance between minimizing false positives and false negatives is essential in statistical analysis.

    Understanding Power in Clinical Trials

    Understanding power is crucial when designing any kind of clinical trial or experiment. Power refers to the ability of a study to detect a true effect if it exists. It is determined by factors such as the sample size and the expected difference between treatment groups. By analyzing a power table, researchers can determine the number of subjects needed for their study to be statistically significant at a certain level. It is crucial to avoid underpowering a study, where there are not enough participants to detect a true effect, as well as overpowered studies, which may find statistically significant but clinically irrelevant results. By appropriately considering power, researchers can ensure the validity and relevance of their findings.

    The importance of power in experimental studies and the significance of considering both relative and absolute risk in interpreting study findings.

    Power in experimental studies is crucial and often overlooked. When evaluating a study, it is important to consider if it was adequately powered to detect a difference between the groups being studied. This information is usually found in the study's power analysis or protocol. Understanding the effect size being looked for and the number of participants needed helps determine the reliability of the study's findings. Additionally, researchers often report relative risk without providing absolute risk, which can be misleading. Knowing both the relative and absolute risk is critical in fully understanding the implications of a study. As seen in the example of hormone replacement therapy and breast cancer, the relative risk increase was reported as 25%, but the absolute risk increase was only 1 case per 1000 women, highlighting the importance of considering both measures.

    Understanding Hazard Ratios and Absolute Risk Reduction in Clinical Trials

    Understanding hazard ratios and absolute risk reduction is crucial in analyzing clinical trials and making informed decisions. Hazard ratios, calculated using complex math, measure the association between two groups over time. They provide valuable insights into the risk of disease progression or benefits of a treatment. Meanwhile, absolute risk reduction focuses on the actual decrease in events and is essential in determining the number needed to treat (NNT) to achieve a desired outcome. By dividing 1 by the absolute risk reduction, we can determine how many individuals need to receive the treatment to prevent the event. This knowledge is vital as it allows us to evaluate the effectiveness, side effects, and costs of treatments, ensuring informed decision-making.

    Evaluating Drug Effectiveness: The Number Needed to Treat (NNT) and Confidence Intervals

    The Number Needed to Treat (NNT) is a valuable measure when evaluating the effectiveness of a drug or treatment. A lower NNT indicates a more significant impact. For example, if a drug reduces the risk of death from 4% to 2%, the NNT would be 50, which is impressively low. On the other hand, if the reduction is from 4% to 1%, the NNT would be 33, indicating an even more substantial effect. Additionally, confidence intervals play a crucial role in interpreting study results. A wider interval suggests greater uncertainty, while a narrower interval suggests more confidence in the findings. When the confidence interval includes the value of 1, the results are not considered significant. Understanding NNT and confidence intervals helps healthcare professionals make informed decisions about treatments and interventions.

    Understanding confidence intervals and the importance of critical thinking in interpreting scientific information.

    When interpreting studies and scientific information, it is important to understand the concept of confidence intervals and uncertainty. A wider confidence interval indicates greater uncertainty, while a narrower interval indicates more confidence in the results. It is crucial to carefully analyze and consider the confidence intervals presented in studies to evaluate the reliability of the findings. Additionally, when reading scientific papers, it is important to be diligent, pay attention to details, and continuously educate oneself. Science requires critical thinking and the ability to understand statistical concepts. Therefore, relying solely on media or social media platforms for science information may not provide accurate or comprehensive understanding. Finally, studies may be stopped midway due to safety concerns, significant benefits observed, or futility in obtaining meaningful results.

    Importance of Prioritizing Patient Safety in Clinical Trials

    Sometimes clinical trials need to be stopped early for safety reasons. This was exemplified by the case of the CTAP inhibitor study, where the trial was set up to compare the combination of the inhibitor with Lipitor to Lipitor alone. The trial intended to follow patients for almost five years, but a monitoring board discovered that a higher number of patients receiving the drug combination had died compared to those on Lipitor alone. This prompted the board to advise Pfizer to halt the trial, which they did. It's important to note that even though the trial was stopped early, a published paper was still produced, reporting the endpoints at the time of study termination. This example demonstrates the significance of prioritizing patient safety in clinical research.

    Importance of rigorous evaluation and research in pharmaceutical development and drug trials.

    Pharmaceutical companies need to carefully evaluate the effectiveness and safety of their drugs before proceeding with trials and releasing them to the market. The example of CTP inhibitors and the different outcomes observed in previous trials highlight the importance of thorough research and analysis. Even small changes in drug molecules can significantly impact their efficacy and potential side effects. Additionally, the discussion on the Look ahead trial emphasizes the need for futility analysis to determine whether further study is warranted. The process of getting a paper published in a journal also requires rigorous peer review to ensure the quality and credibility of the research. Transparency and consideration of conflicts of interest are vital in this process.

    Overcoming Publication Bias Through Preregistration

    Publication bias poses a significant problem in the scientific community. Many studies, even if they are negative or do not yield the desired results, do not get published. This leads to a lack of comprehensive knowledge and hinders scientific progress. It is crucial to overcome publication bias by implementing strategies such as preregistration. Preregistration requires investigators to register their experiments, including statistical methods, number of subjects, and primary and secondary outcomes, before conducting the study. By making preregistration a prerequisite for publication in scientific journals, it becomes more difficult to selectively publish only positive or favorable results. This helps prevent the distortion of scientific knowledge and supports unbiased decision-making in future research endeavors.

    The benefits of registered reports in combating publication bias and improving research quality.

    Registered reports are a valuable tool for combating publication bias and ensuring the establishment of knowledge based on rigorous research. With registered reports, researchers submit their protocols for peer review before data collection, and if the protocol is deemed high quality and everything looks good, the study is provisionally accepted for publication. This eliminates the bias towards positive findings and encourages the publication of negative or neutral results that are equally important for the advancement of knowledge. Additionally, registered reports provide an opportunity for peers to identify flaws in study design, such as underpowered experiments, and offer suggestions for improvement. The conversation also highlights the importance of considering the impact factor when evaluating the reputation of journals, with higher impact factors indicating greater citation and recognition within the scientific community.

    Evaluating the Clinical Significance of Scientific Journals and the Role of Outliers

    The impact factor and number of citations of scientific journals can indicate their clinical significance. Journals like the New England Journal of Medicine, Lancet, and JAMA are considered highly influential because of their high impact factors and large number of citations. However, there are outliers like the cancer journal for clinicians, which has a high impact factor despite fewer citations due to its focus on cancer statistics. The process of reading a scientific paper involves first evaluating the abstract to determine interest, then delving into the methods section for details on the study design. Figures and tables in the results section should be stand-alone and easily understandable. Lastly, the discussion section provides additional insights and allows for comparing one's own thoughts with the authors'. Mentorship, as exemplified by Steve Rosenberg's approach, emphasizes the importance of creating figures and tables early in the research process.

    Mastering Figures and Tables: The Key to Writing a Successful Paper

    Peter Attia believes that understanding the relevant figures and tables and being able to explain them concisely in a legend is crucial for writing a successful paper. He suggests that once you have this foundation, the rest of the paper comes together easily, with the methods and results sections being straightforward to write. Attia also emphasizes the importance of providing valuable content without relying on paid ads and instead relying on member subscriptions for support. By offering premium membership benefits such as comprehensive show notes, AMA episodes, a premium newsletter, and access to a private podcast feed, he aims to provide members with more value than the cost of the subscription. Additionally, Attia acknowledges that the information shared on his podcast is for informational purposes only and not a substitute for professional medical advice.

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    • Back to the day of the dreadful race [53:00];
    • What Peter believes caused the crash [1:02:45];
    • Views on dying young, in the prime of life [1:13:00];
    • Senna lives on in his foundation and in safety changes adopted by F1 [1:21:00];
    • Statistics aren’t enough for fandom, and why people like who they do [1:24:15];
    • The biggest difference between F1 today and F1 in the 80s [1:28:30];
    • Senna’s driving superpower [1:30:30];
    • The fastest drivers currently in F1 [1:38:30];
    • Current F1 obsessions [1:45:00];
    • How hard it is to do what the top F1 drivers do [1:50:15];
    • Dax’s love of motorcycles and his AMG E63 station wagon [1:52:15];
    • Awesome Senna mementos from Etsy [2:01:15];
    • What makes specialists interesting, and Max’s devotion to F1 [2:10:15];
    • What Senna might have done if he had not died that day [2:14:00];
    • Michael Schumacher and Max Verstappen are also top F1 drivers [2:17:30];
    • Interlagos in Sao Paulo Brazil is always an incredible experience [2:18:45]; and
    • More.

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    #299 ‒ Optimizing muscle protein synthesis: the crucial impact of protein quality and quantity, and the key role of resistance training | Luc van Loon, Ph.D.

    #299 ‒ Optimizing muscle protein synthesis: the crucial impact of protein quality and quantity, and the key role of resistance training | Luc van Loon, Ph.D.

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    Luc van Loon is an internationally renowned expert in skeletal muscle metabolism. In this episode, Luc starts with an exploration of the roles of insulin and triglycerides in endurance exercise, highlighting their impact on skeletal muscle metabolism, and he offers profound insights into the significance of protein in this context. He elucidates how different protein types and forms influence muscle protein synthesis rates, exploring the nuances of protein absorption, digestibility, amino acid quality, and their implications for performance and recovery. Delving deeper, he differentiates between animal and plant protein sources, unraveling the distinctive properties of various protein types, from the differences between whey and casein to the emerging trends in collagen protein supplementation. Moreover, Luc dissects the intricate connections among physical activity, lean muscle mass, muscle protein synthesis induced by resistance training, and dietary protein.

    We discuss:

    • Luc’s background and insights about fuel selection during exercise [3:30];
    • Fuel utilization during endurance exercise [9:30];
    • Fat metabolism, intramuscular lipids, and the nutritional dynamics of endurance sports [17:15];
    • The optimal window for replenishing intramuscular fat stores and glycogen post-exercise [25:15];
    • Luc’s interest in protein metabolism and exploration of amino acids' dual role as building blocks and signaling molecules in driving muscle protein synthesis [32:15];
    • How protein metabolism differs between sedentary individuals and those engaged in predominantly strength training or endurance training [38:45];
    • The basics of how proteins are digested and absorbed, and how muscle protein synthesis is measured [50:30];
    • How factors like food texture, cooking methods, and protein composition impact muscle protein synthesis, and the importance of protein distribution throughout the day [59:45];
    • Differences in whey and casein proteins, and the ability of ingested protein to stimulate muscle protein synthesis [1:03:30];
    • Dietary protein distribution and quantity for the maximization of muscle protein synthesis [1:09:00];
    • Muscle loss with age and inactivity and the importance of resistance exercise to maintain type II muscle fibers [1:17:15];
    • Differences between whey and casein proteins, and the importance of both quantity and quality of protein sources [1:28:30];
    • Optimizing muscle protein synthesis: exercise, timing of protein intake, protein quality, and more [1:37:00];
    • How to preserve muscle while trying to lose weight [1:46:00];
    • Anabolic resistance and overcoming it with physical activity [1:55:45];
    • Importance of protein intake and physical activity in hospitalized patients [2:06:30];
    • Reviewing the efficacy of collagen supplements [2:13:30];
    • Plant-based diets: how to ensure a balance of amino acids, and other considerations [2:20:30];
    • Future research: understanding protein metabolism in the brain [2:23:45]; and
    • More.

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    #298 ‒ The impact of emotional health on longevity, self-audit strategies, improving well-being, and more | Paul Conti, M.D.

    #298 ‒ The impact of emotional health on longevity, self-audit strategies, improving well-being, and more | Paul Conti, M.D.

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    Paul Conti is an author and practicing psychiatrist who specializes in helping people heal from trauma. In this episode, Paul returns to The Drive to delve into the intricate relationship between emotional health, healthspan, and lifespan. He first challenges common assumptions about the inevitable decline of emotional health with age, providing strategies for conducting a comprehensive audit of internal emotional health. He establishes a framework for the foundation of good emotional health: a balance between the generative drive, the assertive drive, and the pleasure drive. Paul also explores the nuanced dynamics of motivation, happiness, and satisfaction as it relates to material possessions, draws connections between physical and emotional well-being, confronts the impact of negative self-talk, and describes how making peace with our mortality can foster a sense of hope, purpose and well-being. Additionally, Paul offers many practical insights into initiating emotional health improvements and navigating the search for a suitable therapist.

    We discuss:

    • The importance of prioritizing emotional health as we age [2:45];
    • The impact of emotional health on healthspan and how to foster a proactive approach to emotional well-being [7:00];
    • The discrepancy between outward success and inner fulfillment, and the importance of a healthy “generative drive” for genuine well-being [13:00];
    • A deeper dive into generative drive: impact on human behavior, resilience, purpose, and more [23:15];
    • Evaluating one’s inner self: introspection, self-awareness, challenging societal norms, and returning to the basics of physical and emotional well-being [29:00];
    • Self-auditing tools: introspection, curiosity, and exploring underlying reasons for unwanted behaviors [41:45];
    • Breaking free from destructive cycles by understanding the continuum of self-care and addictive behaviors and remaining curious [50:15];
    • Critical self talk: the malleability of one’s inner dialogue and the potential for transformative change with perseverance and self-compassion [1:00:15];
    • Slowing the anger response and gaining insights into the underlying triggers to achieve lasting change and self-understanding [1:13:45];
    • Foster gratitude and humility by achieving balance between the three drives—assertion, pleasure, and generative [1:20:45];
    • The conflict between intellectual understanding and emotional feelings, problematic comparison frameworks, and the importance of living in the present with intentionality [1:24:15];
    • How making peace with our mortality can foster a sense of hope, purpose and well-being [1:34:45];
    • Advice for finding a compatible therapist [1:43:45];
    • The key components of therapeutic progress [1:57:00];
    • The caricatures of four common patient phenotypes, and how to get through to them [2:05:30];
    • How Paul manages his own well-being and the emotional challenges that come with his line of work [2:15:15]; and
    • More.

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    #297 - AMA #58: Iron: its role in health, testing methods, and strategies for preventing and managing iron deficiency

    #297 - AMA #58: Iron: its role in health, testing methods, and strategies for preventing and managing iron deficiency

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    In this “Ask Me Anything” (AMA) episode, Peter delves into the crucial yet often overlooked topic of iron and iron deficiency. He explores why iron is indispensable for the body, explains the repercussions of iron deficiency, and sheds light on the prevalence of this issue and who is most susceptible. Peter outlines strategies for increasing iron levels, covering dietary iron, supplementation, and infusion options, while also discussing the suitability of each approach for different individuals. Shifting gears, Peter tackles rapid-fire questions on creatine and sodium, as well as inquiries related to his book.

    If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #58 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

    We discuss:

    • Overview of today’s topics and the importance of understanding iron levels in the body [1:45];
    • The importance and ubiquity of iron in the body, and the role of the protein called ferritin [4:30];
    • The processes of iron absorption, utilization, and transportation [9:30];
    • Options for testing iron levels and how to interpret the results [13:45];
    • What does it mean to be iron deficient, and how is it different from anemia? [17:15];
    • Symptoms of iron deficiency and/or anemia [22:15];
    • How prevalent is iron deficiency, and who is most susceptible? [24:30];
    • The importance of consuming an adequate amount of iron daily to prevent deficiency [30:30];
    • The best way to improve iron levels for someone who is deficient [34:45];
    • Iron supplementation: various formulations and potential side effects [37:45];
    • Intravenous iron infusion as an alternative to oral supplements -- plus restless legs syndrome and other topics [42:00];
    • Iron supplementation: who should and should not consider it [44:00];
    • Peter’s approach to creatine and his pre- and post-workout supplements [50:15];
    • Navigating sodium intake: effect on blood pressure, who should use precaution, and other considerations [54:45];
    • Peter’s thoughts about the potential of writing another book [57:15]; and
    • More.

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    #296 ‒ Foot health: preventing and treating common injuries, enhancing strength and mobility, picking footwear, and more | Courtney Conley, D.C.

    #296 ‒ Foot health: preventing and treating common injuries, enhancing strength and mobility, picking footwear, and more | Courtney Conley, D.C.

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    Courtney Conley is an internationally renowned foot and gait specialist. In this episode, Courtney delves into the intricate world of foot anatomy and functionality. She explores the complexities of the foot, discussing its anatomy, common injuries, and the importance of understanding its structure in preventing issues. She covers a range of foot ailments, factors contributing to them, treatment options, and prevention strategies. She delves into the significance of loading, balance, range of motion, and posture, emphasizing the crucial role of strength in preventing both injuries and falls. Additionally, she sheds light on the interconnectedness of the kinetic chain, from the leg muscles down to the foot, and how issues within this chain can cascade downstream, leading to various injuries and pathologies. Additionally, she provides a comprehensive overview of footwear, discussing suitable options for both adults and children to promote foot health and mitigate potential problems.

    In addition to this interview, Courtney also recorded a series of videos to better explain a number of the concepts discussed such as diagnostic tests that are used to determine mobility and strength and the exercises one should perform to improve the outcomes based on the diagnostics. The interview will be available to everyone while the videos from the gym will only be available to paid subscribers (found at the end of the show notes page).

    We discuss:

    • Why Courtney chose to specialize in the foot [3:30];
    • The vital role of foot strength, function, and health in human movement and well-being [6:15];
    • Anatomy of the rear foot and midfoot [10:15];
    • The development of flat feet, the impact of footwear, and the benefits of going barefoot [19:45];
    • Anatomy of the forefoot, common injuries, and why most injuries occur in the forefoot [23:15];
    • Foot musculature and its role in maintaining foot stability and preventing deformities like bunions and hammer toes [30:15];
    • The intrinsic musculature of the foot, plantar fasciitis, footwear, and more [39:00];
    • Plantar fasciitis: diagnosis, causes, and treatment [51:30];
    • Posterior leg muscles: strength assessment methods, role in ACL injuries, and more [59:15];
    • Lateral and medial muscles: ankle stability, arch support, big toe stabilization, and exercises to strengthen and prevent injuries [1:04:15];
    • Importance of strength of lower leg muscles for gait and preventing shin splints, stress injuries, and more [1:08:15];
    • Tendinopathies and other common pathologies related to the anterior and lateral compartments of the foot [1:13:00];
    • The importance of midfoot integrity, ankle dorsiflexion, and a discussion of gait alterations [1:19:45];
    • Proximal stability and its implications for posture and movement patterns [1:27:00];
    • The age-related decline in foot sensation and strength [1:32:45];
    • Common toe injuries, treatment, and how to prevent further progression of the injury [1:36:30];
    • Preventing falls and managing arthritis with proactive foot care and exercises [1:46:45];
    • Footwear: advice for picking shoes that promote foot health [1:54:45];
    • Footwear for runners [2:05:30];
    • The importance of prioritizing footwear that promotes natural foot movement and strength while considering individual comfort and foot health needs [2:09:30]; and
    • More.

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    #295 ‒ Roadway death and injury: why everyone should care and what you can do to reduce risk | Mark Rosekind, Ph.D.

    #295 ‒ Roadway death and injury: why everyone should care and what you can do to reduce risk | Mark Rosekind, Ph.D.

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    Mark Rosekind is an expert on road safety and a policy leader with more than 30 years of experience enacting strategic, practical, and effective data-based solutions that enhance driver and pedestrian safety and health in complex environments. In this episode, Mark delves into the persistent issue of accidental deaths resulting from roadway accidents, a concern for those focused on longevity given its consistent risk throughout life. From exploring statistics on car crashes to identifying the demographics most at risk and the key locations of incidents, he uncovers various risk factors including distractions like smartphone usage, the influence of alcohol and cannabis, the dangers of sleep deprivation, and speeding. Mark also provides practical advice for both drivers and pedestrians to enhance safety, while delving into the potential and challenges of emerging technologies such as autonomous vehicles. Additionally, Mark provides valuable resources for listeners, particularly parents navigating the road safety landscape with teenage drivers.

    We discuss:

    • Mark’s background and education, and the profound impact of transportation accidents on human lives [4:15];
    • From sleep science to safety leadership: Mark’s journey in transportation innovation [14:15];
    • Stats on transportation accidents and fatalities [18:00];
    • Historical trends in road fatalities and the key contributors—impairment, distraction, and more [28:00];
    • The demographics of drivers involved in crashes, and the life-saving potential of better driver education programs [34:30];
    • The most critical areas where drivers need to be hyper-aware to protect themselves [41:00];
    • The role of the National Transportation Safety Board (NTSB) in accident investigations, and the importance of data sources like event data recorders (EDRs) in accident reconstruction and investigations [47:00];
    • The dangers of phone use while driving [53:45];
    • How drunk driving was addressed through advocacy and legal changes [1:01:30];
    • The need to address distracted driving and the psychological impact of distracted driving accidents on both victims and perpetrators[1:07:15];
    • Navigating the roads and lowering your risk of accidents: weather, human error, and defensive driving [1:15:45];
    • The impact of impaired driving: alcohol, cannabis, prescription drugs, and more [1:26:15];
    • Mitigating the effects of vehicle speed [1:38:15];
    • The promise and challenges of autonomous vehicles for road safety [1:44:15];
    • Automatic emergency braking (AEB): the effectiveness and challenges of implementing AEB as a standard feature in new vehicles [1:53:00];
    • Sleep deprivation: the impact of poor sleep, drowsiness, and disrupted circadian rhythm on driving [1:58:15];
    • Protecting pedestrians: strategies for reducing the risk of fatal accidents with pedestrians on foot or bicycle [2:02:30];
    • Empowering safe driving: essential resources and tips for parents and teenage drivers [2:14:00];
    • Promoting a culture of proactive safety: parting thoughts from Mark [2:19:15]; and
    • More.

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    #294 ‒ Peak athletic performance: How to measure it and how to train for it from the coach of the most elite athletes on earth | Olav Aleksander Bu

    #294 ‒ Peak athletic performance: How to measure it and how to train for it from the coach of the most elite athletes on earth | Olav Aleksander Bu

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    Olav Aleksander Bu is an internationally renowned sports scientist acclaimed for his coaching prowess with elite athletes spanning a diverse range of sports disciplines. In this episode, Olav delves deep into the intricacies of VO2 max and its profound impact on performance. They explore the relationship between VO2 max and ATP production, energy efficiency, and power, as well as the impact of low-intensity training on VO2 max. The conversation extends to Olav’s experiences pushing the boundaries with high-performance athletes and the data driven interventions he uses to improve performance. They also dissect the role of lactate threshold, discuss other important metrics to track, and explore the exciting possibility of utilizing a portable VO2 testing device as a practical alternative to traditional lab-based assessments.

    We discuss:

    • Olav’s background, expertise in exercise physiology, coaching experience, and interest in the extremes of human capability [4:15];
    • The processes of energy conversion within the human body and its implications for performance [9:30];
    • Improving movement efficiency, and the importance of mindfulness in training to optimize performance [20:00];
    • The relationship between VO2 max, power output, and endurance performance in different sporting contexts [34:45];
    • How VO2 max is measured in the lab, and why it’s a crucial predictor of both lifespan and quality of life [44:45];
    • Absolute vs relative VO2 max, the significance of functional threshold power in cycling, and the importance of longer duration tests for accurate assessments [54:00];
    • Portable VO2 testing devices as a practical alternative to lab-based tests [1:05:15];
    • The complexities of measuring ventilation and its impact on performance metrics like VO2 max and heart rate [1:15:45];
    • Training interventions to increase VO2 max, and factors that impact performance outcomes [1:23:30];
    • The respiratory exchange ratio (RER) and endurance sports, and how factors such as diet composition and exercise intensity influence RER values and performance [1:32:45];
    • Science-guided training for versatile athletes: maximizing VO2 max, power, torque, and cadence in cycling, and the importance of incorporating diverse stimuli to enhance performance [1:41:00];
    • Physiological limitations on VO2 max [2:02:15];
    • The different energy systems used during work, and other things to monitor like VCO2 and heart rate [2:06:00];
    • Lactate threshold and other metrics to guide your training [2:10:30];
    • Analysis of a lactate power curve: exploring lactate dynamics in endurance training and performance [2:23:15]; and
    • More.

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