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    #36 - Eric Chehab, M.D.: Extending healthspan and preserving quality of life

    enJanuary 14, 2019
    What are common joint injuries mentioned by Eric Shahab?
    When should patients consider surgery over physical therapy?
    What does the study say about meniscus tears treatment?
    How can orthopedic health impact mobility later in life?
    Why is passion important in medicine and sports?

    Podcast Summary

    • Prioritizing Orthopedic Health for a Longer, Better LifeUnderstanding and preventing common joint injuries can help maintain optimal mobility and functionality, mitigating potential problems later in life. Physical therapy may be a better option than surgery in some cases.

      Taking care of our orthopedic health is crucial for living a longer and better life. Orthopedic surgeon Eric Shahab emphasizes the importance of understanding common joint injuries and how they can be prevented. He discusses knee pain caused by incorrect form and weightlifting, shoulder injuries from overhead exercises, wrist, elbow, and ankle injuries, Achilles tendon issues, and lower back flare-ups. By recognizing the potential problems that arise later in life, we can take steps to mitigate them earlier. The conversation also delves into topics like when physical therapy is a better option than surgery, the controversy surrounding meniscus surgery, and the nature of pain. Ultimately, prioritizing orthopedic health can prevent limitations in mobility and keep us functioning optimally in our daily lives.

    • The Power of Bruce Springsteen's Music: Fan Experiences and ImpactBruce Springsteen's music creates lasting memories and a sense of connection between the artist and his fans, demonstrating the power of music to deeply resonate with people.

      Bruce Springsteen is considered by many to be one of the coolest guys ever. Eric Chehab, a fan of Springsteen, shares his experiences of attending multiple concerts and the impact they had on him. From seeing Bruce at a young age during the "Born in the USA" tour to traveling all the way to Verona, Italy, just to attend a show, it is evident that Springsteen's music deeply resonates with his fans. Despite the loss of Clarence Clemons, a key member of the E Street Band, Springsteen continues to deliver exceptional live performances, showcasing his talent and dedication. The story emphasizes the power of music to create lasting memories and a sense of connection between artist and audience.

    • The timeless and connecting power of music.Music has the ability to evoke strong emotions and create connections between people of different generations, highlighting its enduring power to bring people together.

      Music has a profound impact on people of all ages and generations. The emotions and joy experienced by concert-goers, even as they grow older, are a testament to the timelessness of music. Whether it's Pearl Jam, Bruce Springsteen, or any other artist, their music can evoke powerful emotions and create connections between individuals from different backgrounds. The intergenerational aspect of music is also highlighted, as younger fans are introduced to artists through their parents, forming a shared love for the music. This conversation emphasizes the enduring power of music to bring people together and create lasting memories, regardless of age or talent.

    • The Impact of Attending Harvard and the Changing Landscape of College AdmissionsAttending a prestigious university like Harvard can provide significant advantages in career opportunities, but the evolving nature of college admissions calls for individuals to make the most of the opportunities available to them.

      Attending prestigious universities, like Harvard, can open doors and provide significant advantages in terms of career opportunities. Eric reflects on the impact of attending Harvard and how it shaped his trajectory. He shares his surprise when some individuals hesitate to mention their affiliation with the university, emphasizing the benefits of being associated with such an esteemed institution. However, Eric acknowledges that the college admissions landscape has changed drastically, with increased competition and fewer opportunities for admission. He recognizes that his own children face a more challenging process. This conversation highlights the importance of education and the evolving nature of college admissions, urging individuals to make the most of the opportunities available to them.

    • A detour on the path to medicineExploring different paths can lead to discovering our true passion and purpose in life.

      Sometimes life takes us on unexpected paths before leading us to where we truly belong. Eric Chehab had a strong familial connection to the medical field, with both his mother and grandfather being involved in healthcare. However, he took a detour after college and spent three years teaching high school chemistry overseas. Though teaching was enjoyable, Eric felt that medicine was his true calling. The teaching experience provided him with valuable life lessons and helped him mature before pursuing a career in medicine. This shows that sometimes it's necessary to explore different paths before finding our true passion and purpose in life.

    • Breaking Stereotypes: Two Medical Professionals Share Their Unique Paths to SuccessChallenging assumptions and embracing individuality can lead to fulfillment and purpose, even in career choices that may go against societal norms or stereotypes.

      Our initial perceptions and stereotypes can often be misleading. Peter Attia and Eric Chehab discuss their friendship and career paths, highlighting the misconceptions they faced as individuals in the medical field. Despite being viewed as "testosterone knucklehead guys," they both took unique and winding paths to their success. Eric was torn between internal medicine and orthopedics, a decision that goes against the stereotype that all athletes choose orthopedics. In reality, orthopedics requires careful thought and is not simply about fixing broken bones. Eric's decision to pursue orthopedics ultimately brought him fulfillment and a sense of purpose in the operating room. This reminds us to challenge assumptions and embrace individuality rather than conforming to societal norms or stereotypes.

    • The Power of Meaningful RelationshipsMeaningful connections with others, regardless of blood ties, can have a significant impact on our lives and provide support, care, and guidance when needed most.

      Relationships can have a significant impact on our lives, even those that are not blood-related. Eric Chehab's neighbor, Bill Hensler, became a father figure to him when he had no contact with his biological father. Bill supported and cared for Eric, attending his events and being there for him. When Bill faced difficulties, Eric's mother intervened and helped him overcome his alcoholism. Eric's decision to pursue his medical training in New York was driven by his desire to be closer to Bill as his health declined. This story emphasizes the importance of meaningful connections and the profound influence they can have on our lives, regardless of blood ties.

    • The Power and Influence of Meaningful ConnectionsThe connections we form with others can have a profound impact on our lives, shaping our paths, values, and overall well-being.

      Relationships can have a profound impact on our lives, even in unexpected ways. Eric Chehab shares his touching connection with Bill, a father figure who made a significant difference in his life. Despite the challenges and losses they faced, Bill's presence brought joy, laughter, and healing to Eric. This connection shaped Eric's path and influenced his decision to write about Bill in his medical school application. It reminds us that the people we encounter along our journey can leave lasting impressions, guiding us towards our aspirations and shaping our values. It also highlights the power of genuine human connections and the impact they can have on our overall well-being.

    • Reflecting on Unexpected Influences and Toxic RelationshipsThe importance of open-mindedness and genuine connections, as well as the need to distance ourselves from toxic familial dynamics for the well-being of future generations.

      Life can sometimes be serendipitous, with chance encounters and unexpected influences shaping our paths. Eric Chehab reflects on how his neighbor became one of the most meaningful influences in his life, highlighting the importance of open-mindedness and genuine connections. On the other hand, his relationship with his father is strained, with limited communication and a lack of emotional connection. This serves as a reminder that not all relationships are meant to be deeply meaningful, and sometimes it's necessary to distance ourselves from toxic familial dynamics. Eric's contemplation about exposing his own children to this kind of relationship demonstrates the importance of considering the well-being and emotional stability of future generations. Overall, this conversation emphasizes the complexities and unpredictability of human relationships, and the need for self-reflection and decision-making in navigating them.

    • Reflections on Life's Unexpected Turns and the Power of ChoiceLife is unpredictable, and our choices can have significant consequences. It is important to be mindful of our decisions and empathize with others who may be in difficult situations.

      Life is full of unexpected twists and turns, and one wrong decision can lead to significant consequences. Peter Attia expresses empathy towards people in difficult situations, recognizing that there may be underlying factors that contribute to their actions. He reflects on his own brush with potential trouble, realizing how close he came to making a detrimental choice. Eric Chehab shares a humorous anecdote about canceling a date to share a ham with a friend, highlighting the unpredictability and spontaneity of life. The story serves as a reminder to be mindful of the choices we make and the influence they can have on our lives.

    • Taking a risk for love and authenticityBeing genuine and expressing your emotions, even after mistakes, can lead to unexpected positive outcomes and second chances.

      Sometimes taking a risk and being authentic with your feelings can lead to unexpected positive outcomes. Eric Chehab shares a story where he initially fumbles a date but musters up the courage to turn his car around and express his true feelings to the woman he is interested in. Despite his initial blunders and awkwardness, his sincere and straightforward approach resonates with her. This highlights the importance of being genuine and not being afraid to express one's emotions, even if it means being vulnerable. It also serves as a reminder that taking the opportunity to rectify mistakes and make amends can lead to second chances and new beginnings.

    • Excellence in Orthopedic Education and Patient Care at HSSThe Hospital for Special Surgery is a renowned institution that prioritizes resident education, provides exceptional patient care, and maintains a strong foothold in the field of orthopedic surgery.

      The Hospital for Special Surgery (HSS) is an exceptional orthopedic institution with a strong focus on education and patient care. Located in New York, HSS is renowned for its expertise in joint replacement surgery and has played a significant role in advancing this field. The hospital boasts giants in the orthopedic field, such as Chip Ronawat, Tom Sculco, and Philip Wilson, who have contributed to its reputation. Residents at HSS benefit from a unique learning environment, with daily teaching conferences and a high volume of surgeries, allowing for continuous knowledge absorption. The dedication to resident education and the emphasis on providing the best care possible is evident in HSS's work ethic and endless demand for their services. Driven individuals like Russ Warren, one of the godfathers of sports medicine, exemplify this dedication and work tirelessly to stay at the forefront of their field, never wasting a minute.

    • Passion and Excellence in Medicine and SportsSuccess in any field is driven by passion, expertise, continuous improvement, and a genuine love for what we do.

      The individuals mentioned in the story are extremely passionate about their respective fields and excel in their work. Eric Chehab speaks highly of Dr. Polici, a gifted joint replacement surgeon known for his speed and precision. He also praises Dr. Rodeo, a clinician scientist who provides excellent care to his patients. Additionally, Eric discusses his own experience with the New York Giants, where he witnessed the dedication and resilience of the athletes. The story emphasizes the importance of passion, expertise, and continuous advancement in various fields, whether it be medicine or sports. It reminds us that success comes from a combination of skill, hard work, and a genuine love for what we do.

    • The Extraordinary Physical Abilities and Challenges Faced by Professional NFL PlayersProfessional football players showcase incredible athleticism, but making it into the league requires a narrow margin of skill. Once in, it becomes crucial to prioritize health and injury prevention amidst the game's violent nature.

      Professional athletes, especially those in the NFL, are extraordinary physical specimens. Eric Chehab is in awe of the sheer athleticism displayed by these players in training camp. He emphasizes that the gap between a superstar athlete and those who don't make it into the league is extremely narrow. Furthermore, the discussion highlights the importance of longevity and injury prevention once players reach the NFL. Ryan Flare, a speed training guru, explains that the focus shifts from performance to maintaining health and avoiding injuries. The violence and intensity of the game are also underscored, with high-energy collisions compared to car wrecks. This conversation emphasizes the exceptional physical abilities and immense challenges faced by professional football players.

    • The Hidden Demands of Professional FootballProfessional football players face intense physical demands, short careers, and high injury rates, emphasizing the need to acknowledge their athleticism, stress, and challenges.

      People often underestimate the athletic abilities and stress levels of professional football players. Despite their size and appearance, linemen can run incredibly fast, with some completing a 40-yard dash in less than 5 seconds. These players undergo intense training and face constant competition to secure their positions and contracts. The physical demands of the game result in high injury rates, especially for running backs and linebackers. Players' careers are typically short-lived, with the median tenure in the NFL being only 3 to 4 years. The combine, a pre-draft evaluation event, reveals the extensive medical history and injuries of players, highlighting the physical toll the sport takes on them. Therefore, it is important to recognize the athleticism, stress, and challenges faced by professional football players.

    • The risks of football: weighing the benefits against the dangersDespite the known risks, parents may choose to allow their children to play football due to the joy and personal growth it can provide, emphasizing the importance of considering long-term effects on individual development.

      Playing football at a high level inevitably exposes players to injuries, but the love for the game and the potential benefits outweigh the risks for some individuals and their families. Despite being aware of the dangers of playing football and the increasing concerns surrounding CTE, Eric Chehab allows his youngest son to participate because he sees the joy and personal growth his son derives from the sport. While the decision to let a child play football involves weighing the pros and cons and is a personal one for each family, it highlights the significance of considering the long-term effects of the sport on individual development.

    • Understanding knee health and preventing injuriesProtecting and preserving the knee's cartilage is crucial for maintaining a pain-free and active lifestyle while minimizing the risk of orthopedic injuries.

      The knee is a complex joint that is incredibly good at bearing weight and supporting our weight. However, the cartilage in the knee wears down over time, causing pain and slowing people down. While living without an ACL is possible, it can lead to instability in the knee. If given the opportunity, the speaker would make the cartilage immortal to prevent knee arthritis and the need for knee replacements. It is important to understand the intricacies of orthopedic injuries, as many people have personally or indirectly experienced them. By focusing on preserving the health and function of the knee, individuals can lead productive and active lives while minimizing the risk of injury.

    • Understanding the anatomy of the knee and its impact on injuries and stability.The knee joint consists of various components, including ligaments, cartilage, and menisci, which play essential roles in maintaining knee function and stability.

      Understanding the anatomy of the knee is crucial to comprehending knee injuries and their impact. The knee joint consists of the tibia and the femur, with the tibial plateau providing a surface for the cartilage. Ligaments like the MCL and LCL control side-to-side movement, while the cruciate ligaments ensure rotational stability. Tearing the ACL often occurs due to rotational injuries, while the PCL is more commonly torn from direct blows. The menisci sit on top of the tibial plateau, distributing contact pressures evenly and providing stability to the knee. Removing or damaging the meniscus can significantly impact knee function and contribute to the deterioration of cartilage. Knee replacements attempt to mimic the functions of the meniscus, indicating their importance in knee mechanics and stability.

    • Preserving Joint Health and Quality of Life: The Meniscus and Articular Cartilage ConnectionMaintaining a healthy weight, engaging in regular exercise, and setting realistic expectations for knee replacements can help delay the loss of articular cartilage, reduce knee pressure, and improve overall joint longevity.

      The status of our meniscus and the health of our articular cartilage greatly impact our overall joint health and quality of life. Losing the meniscus and experiencing damage to the articular cartilage can lead to swelling, pain, difficulty walking, and feelings of instability. While the loss of articular cartilage is inevitable for everyone, it is important to delay this process for as long as possible. Factors like genetics, injury, trauma, weight, and exercise play a role in the longevity of our joints. Maintaining a healthy weight and engaging in regular exercise can significantly reduce the pressure on our knees and delay the need for knee replacements. Additionally, it is crucial to set realistic expectations for knee replacements, as they are typically not as durable or satisfying as our original joints.

    • Managing Knee Issues Through Weight Management and Ortho Health Program.Modifiable factors like weight management and Ortho Health program can help patients with knee issues by improving sleep, stress management, nutrition, and exercise efficiency.

      There are modifiable factors that can help patients with knee issues, particularly weight management. The Ortho Health program focuses on improving sleep, stress management, nutrition, and exercise efficiency. While running puts strain on the knee, the body reacts to stress by laying down more bone, so weight-bearing exercises are emphasized for patients in their thirties to build bone density. However, bone density starts declining around the age of 30, especially for women during menopause. The goal of hormone therapy and exercise is to slow down this decline, although the exact reason for bone loss at a certain age is not fully understood. Pharmacotherapy aims to inhibit osteoclasts, but there are concerns about the quality of bone built with these medications. Currently, the focus is mainly on osteoclastic inhibition rather than activating osteoblasts, although there are thoughts about using magnetic fields to stimulate bone production.

    • Exercise, form, and injury risk: A closer lookWalking offers significant cardiovascular benefits and reduces the risk of cardiovascular disease, but more research is needed to understand the effects of different exercises and their measurable changes on overall health.

      Exercising incorrectly and with poor form can lead to injuries, especially when done repetitively and under load. The emphasis on volume and intensity of exercise within a short time frame due to sedentary lifestyles can increase the risk of injury. Walking, on the other hand, can provide cardiovascular benefits and reduce the risk of cardiovascular disease by 30 to 40%. However, there may be biases in studies conducted on walking and its benefits, as they may involve individuals who have the luxury of being able to walk. Long-term clinical trials with randomization are unlikely to happen, so a combination of short-term clinical studies and better epidemiology can help understand the measurable changes and effects of different exercises. Ultimately, consistent movement throughout the day is crucial for better orthopedic and musculoskeletal health.

    • Tailoring Exercise to Your NeedsFinding the right type and intensity of exercise is important for maintaining overall health and preventing injuries. It is crucial to consider individual factors, listen to your body, and start gradually to achieve long-term fitness goals.

      Finding the right type of exercise is highly individualized and depends on multiple factors such as age, overall health, and personal preferences. While some individuals may benefit from high-intensity workouts, others may find walking to be sufficient for maintaining cardiovascular health. It is important to understand the specific physiologic benefits of different exercises, such as maintaining muscle mass, bone density, and cognitive function. Additionally, considering other lifestyle factors like sleep and nutrition is crucial for overall well-being. Starting with small increments and avoiding overexertion can help prevent injuries and ensure long-term fitness goals. It is essential to listen to one's body and find a balance between exercise and injury prevention. Knee pain and swelling from excessive squats and lunges are common issues that individuals may encounter.

    • Importance of Proper Form and Technique in ExerciseMaintaining correct form and technique during exercises is crucial to prevent injuries and pain, and having a knowledgeable trainer can guide individuals in achieving this. Additionally, focusing on pull exercises can help prevent or recover from shoulder injuries, while tendonopathies in joints can be addressed with similar understanding and treatment.

      Proper form and technique are crucial when it comes to exercises like squats, lunges, and weight training. Incorrect form can put undue strain on the joints, leading to injuries and pain. It is important to have a knowledgeable trainer who can guide individuals in maintaining the correct positions and activating the right muscles. Additionally, shoulder injuries often occur when the shoulder is loaded above the plane of the neck, such as during overhead presses. To prevent or recover from shoulder injuries, it is advised to focus more on pull exercises rather than presses. Tendonopathies are common injuries for elbows, wrists, and other joints, likely caused by biological changes and decreased blood flow. These injuries can be approached with a similar understanding and treatment.

    • Addressing Tendon and Joint Issues: Risks and ControversiesOrthotics and reconstructions can help with tendon issues, while labral tears may not always be the cause of hip pain. Conservative measures should be tried before opting for procedures.

      Tendon deficiencies and wear and tear on joints often lead to pain and mobility issues. In the case of ankles, the Achilles tendon is commonly affected, causing changes in foot shape and loading. The condition can be supported with orthotics or complex foot reconstructions to reduce the strain on the tendon. However, these reconstructions come with risks and not everyone will fully recover. Similarly, the hip joint tends to wear down over time, leading to labral tears and cartilage damage. While labral tears can be observed on MRI scans, they may not always be the cause of hip pain. In some cases, physical therapy and time may resolve the issue, but procedures may be necessary for those who don't respond to conservative measures. The controversy surrounding these conditions and treatments remains within the orthopedic surgery community.

    • Comparing Physical Therapy and Surgery for Meniscus Tears: Finding the BalancePhysical therapy can be a reasonable initial treatment for meniscus tears, but individual patient needs should guide decision-making to avoid unnecessary surgeries.

      The study comparing physical therapy and surgery for meniscus tears should not be interpreted as suggesting that therapy is superior to surgery in all cases. The study actually showed that physical therapy and surgery had similar outcomes, but it is important to note that some patients in the therapy group ended up having surgery as well. The main message of the study was that it is reasonable to start with conservative treatment, such as physical therapy, but there may be a subset of patients who will benefit from surgery. Patients with meniscus injuries should try therapy and give it a month or two to see if their condition improves. If the pain persists or worsens, then surgery may be considered as an option. It is crucial for doctors to make decisions based on individual patient needs rather than external pressures, and unnecessary surgeries should be avoided.

    • The Importance of Separating the Role of Prescribing Medication from Selling ItTo ensure unbiased decision-making, patients should seek healthcare providers who prioritize their well-being and consider seeking multiple opinions when considering treatment options.

      Doctors who have the ability to sell drugs may be tempted to lean towards more expensive options for financial gain, even if they are not the best choice for their patients. This highlights the importance of separating the role of prescribing medication from selling it. While most doctors have their patients' best interests at heart, they are still susceptible to external influences that may compromise their decision-making. The multidisciplinary approach taken in orthopedics, where physiatrists and non-operative sports medicine specialists are involved in the decision-making process, can help mitigate bias and ensure a more balanced perspective. It is essential for patients to seek out healthcare providers who prioritize their well-being and seek multiple opinions when considering treatment options.

    • Seeking Expert Advice for Successful OutcomesFinding top professionals in their fields is crucial in medical treatment and rehabilitation. They can provide alternative solutions, evaluate underlying issues, and prioritize patient well-being over financial gain. Seek their unbiased opinions.

      Finding the best experts in their respective fields and utilizing their expertise can lead to successful outcomes. Peter Attia emphasizes the importance of seeking out top professionals for medical treatment and rehabilitation. He shares his personal experience with a labral tear and an IT band injury, where he initially thought surgery was needed, but the experts he consulted with provided alternative solutions. These experts had the ability to evaluate the true underlying issues causing the pain and discomfort. Attia appreciates their ability to offer unbiased opinions and prioritize the patient's well-being over financial gain. This highlights the importance of seeking unbiased opinions from skilled professionals, even when it goes against their own interests.

    • Trusting Surgeon Recommendations and Being Informed about PRPSurgeons prioritize patients' best interests, but hidden influences can impact decisions. Patients should seek a multidisciplinary approach and be informed about PRP's uncertain benefits and its limitations as a definitive solution for tendinopathy.

      Patients should trust the recommendations of their surgeons based on the physiology of their disease, rather than doubting their intentions. Surgeons, like other medical professionals, prioritize the best interests of their patients. However, there can be hidden influences that may impact decisions, as humans are susceptible to external factors. It is crucial for patients to have access to a multidisciplinary approach, where multiple experts evaluate their case and work together in the patient's best interest. In terms of new treatments like PRP, while it shows some potential in accelerating healing and stimulating tendons, its benefits are still uncertain and may vary depending on the type of preparation used. Ultimately, the effectiveness of PRP depends on individual cases and is not a definitive solution for tendinopathy.

    • The Challenges and Potential of Regenerative MedicineRegenerative medicine, including stem cells and PRP, shows promise but still requires standardization and optimization. The role of the placebo effect and the need for more research highlight the importance of developing comprehensive understanding and reliable outcomes.

      The field of regenerative medicine, specifically stem cells and PRP (Platelet-Rich Plasma), is still in its early stages and lacks standardization and optimization. While there is promise in these treatments, their efficacy and mechanisms of action are not yet fully understood. The placebo effect plays a significant role in patient perception of improvement, particularly with more invasive procedures. The goal is to eventually have a better understanding of which patients are best suited for these procedures and to develop standardized techniques. Currently, there is a lack of effective treatments for arthritis, and patients are seeking alternative options like stem cells and PRP. However, more research and scientific advancements are needed for a comprehensive understanding and reliable outcomes in this field.

    • Lack of scientific evidence and potential for exploitation in stem cell treatmentsApproach stem cell treatments with caution and skepticism due to lack of evidence and possibility of being exploited financially.

      The use of stem cell injections as a treatment option lacks rigorous scientific evidence. While patients may report feeling better, it is unclear whether this is due to a placebo effect, anti-inflammatory properties, or actual cartilage regeneration. Furthermore, the exorbitant prices associated with stem cell treatments suggest a potential for exploitation in the absence of concrete solutions. While randomized controlled trials are ongoing, the process of randomization and blinding in these trials can be complex. It is important to consider the potential harm, both physical and financial, when exploring stem cell therapies. Ultimately, it is crucial to approach stem cell treatments with caution and skepticism until further evidence is available to support their efficacy.

    • Balancing ethical considerations in medical procedures: the dilemma of placebo surgeries and the importance of thorough explanations and research.Prioritizing ethics in medical procedures involves considering the potential benefits of placebo surgeries while ensuring patient trust and providing necessary care through explanations and evidence-based treatments.

      It's important to prioritize ethical considerations when offering medical procedures. The discussion highlights the dilemma faced by surgeons when it comes to placebo surgeries, where patients may not receive any actual treatment but still show improvement. While offering sham surgeries may be ethically sound, it runs the risk of losing the benefits derived from the placebo effect. However, providing thorough explanations to patients about the role of post-operative care and therapy can help bridge the gap. Additionally, the conversation touches upon the need for more research and evidence in the field of orthopedics, especially for common procedures like subacromial decompression. This helps ensure that patients receive effective treatments without being misled. Ultimately, the most ethical approach may involve considering the potential placebo effect while upholding patient trust and delivering necessary care.

    • Overcoming a Debilitating Back Injury and Lessons LearnedApproach back pain management cautiously and consider non-surgical options, especially if neurologic compromise is not present.

      Experiencing a debilitating back injury can have both negative and positive consequences. Peter Attia shares his personal journey of recovering from a back injury, which left him unable to move for three months. He highlights that this challenging experience taught him important lessons in how to protect his back and perform daily tasks without causing further harm. Despite the difficulties he faced, he now considers it the best worst thing that ever happened to him. Additionally, the conversation touches on the controversial topic of back surgeries, with Eric Chehab mentioning that many orthopedic surgeons would not undergo spine surgery themselves due to the potential for poor outcomes. Overall, it is crucial to approach back pain management with caution and consider non-surgical options, especially when neurologic compromise is not present.

    • The Impact and Risks of Spine Surgeries Compared to Joint Replacement SurgeriesSpine surgeries can result in a significant decrease in functionality, while joint replacement surgeries offer a higher potential for improvement. Prospective patients need to carefully consider the risks and consult with trusted orthopedic experts.

      Spine surgeries can have a significant impact on a person's overall functionality and quality of life. Unlike other surgeries, there is a higher chance of taking someone from a reasonably functional state to a much lower functional state in spine surgeries. This is due to the complex nature of the spine and its involvement in the body's core functions. On the other hand, joint replacement surgeries, particularly for hip and knee, have a higher potential for improvement as they often start with individuals who are already experiencing limited functionality and severe pain. It's important for individuals considering spine surgery to weigh the potential risks and benefits carefully and consult with trusted orthopedic experts who can provide specialized advice and recommendations.

    • The importance of surgeon volume and accountability in orthopedic proceduresSurgeons with high volumes of procedures are more experienced and skilled. Look for a surgeon with a substantial number of procedures and who takes responsibility for any complications to ensure quality care.

      When it comes to choosing an orthopedic surgeon for procedures like knee or hip replacements, volume speaks volumes. Surgeons with high volumes of procedures tend to be more experienced and skilled in their field. While some surgeons may have high volumes for financial reasons, it is generally a good rule of thumb to select a surgeon with a substantial number of procedures under their belt. Studies show that a volume of 30 or more procedures per year is considered high, but the truly exceptional surgeons may perform several surgeries a day, totaling 200 or more procedures annually. Additionally, it is crucial to choose a surgeon who is willing to take responsibility for any complications that may arise, as this demonstrates their commitment to patient care and accountability.

    • Choosing a Surgeon: Factors to ConsiderPrioritize finding a surgeon known for handling complications, offering a seamless experience. Ask about their experience with complications, infection, and reoperation rates. Trust and willingness to provide second opinions are crucial. Traditional metrics may not accurately assess surgeon quality.

      When choosing a surgeon, patients should prioritize certain factors. It is important to find a surgeon who is known for dealing with complications and ensuring a seamless experience. This can often be found through word-of-mouth referrals. Patients should not hesitate to ask physicians about their experience with complications, infection rates, and reoperation rates. Surgeons who willingly answer these questions are likely to be trustworthy and focused on the patient's best interests. Additionally, a surgeon who welcomes a second opinion is a positive sign. It is worth noting that traditional metrics, such as health grades, may not accurately gauge the quality of a surgeon. Ultimately, trust plays a significant role in selecting the best surgeon for one's needs.

    • Helping patients cope and adapt to new realitiesPhysicians play a crucial role in helping patients accept their limitations, focus on their abilities, and find ways to live fulfilling lives despite complications or disease progression.

      As physicians, it is crucial for us to help patients cope and adapt to their new realities, especially when complications or the natural progression of a disease leave them with deficits. From a surgeon's standpoint, coping means being able to move on and provide the best care for the next patient despite previous complications. For patients, coping involves focusing on what they are still capable of doing rather than dwelling on their limitations. By changing their mindset and emphasizing their abilities, patients can better accept their new reality and find ways to live fulfilling lives. This idea of coping was highlighted by a breast oncologist, Dr. Eric Weiner, who spoke about his own interactions with medicine and how it is the primary role of physicians to help patients cope.

    • Managing Expectations and Coping with Medical LimitationsFocus on what you can do, explore alternative activities, strengthen your body, and educate yourself to improve well-being and adapt to limitations, enhancing your quality of life.

      Managing expectations and focusing on what you can do rather than what you can't do is crucial when dealing with ongoing medical issues. For individuals in knee purgatory, who may not be ready for joint replacement but are still experiencing limitations, treatment and management should emphasize coping and finding alternative activities that are still active and enjoyable. This includes exploring options like swimming or biking for someone who used to be a runner or tennis player. Additionally, understanding the importance of strengthening, weight management, and educating oneself about the condition or injury plays a significant role in improving overall well-being and adapting to limitations. By continuously striving to push against one's threshold and making efforts to modulate it, individuals can enhance their quality of life and maintain functionality for as long as possible.

    • Focusing on capabilities for better physical decline management.Cultivating a positive mindset and adapting to new activities can slow down physical decline and improve quality of life, especially for women approaching menopause.

      Focusing on what you're capable of doing, rather than what you've lost, can have a significant impact on managing and coping with physical decline. It's not about finding a quick fix or a magical cure, but about cultivating a mindset that allows you to live better and move better. Switching to a different activity or sport can slow down the decline and prevent a sudden decline in physical quality of life. This is especially important for women who are approaching menopause, as it can accelerate the decline. The conversation also highlights the importance of adaptability and finding alternative ways to stay active, whether it's changing techniques or trying different activities. Lastly, it emphasizes that managing joint injuries is challenging and can have long-lasting effects on one's trajectory, but the goal is to minimize the impact and maintain the best possible outcome.

    • Focusing on our current abilities and experiences, despite physical decline, is key to preserving our well-being.Recognize and maximize your current abilities, rather than dwelling on past accomplishments, to maintain a positive outlook and overall quality of life.

      It is important to focus on what we are still capable of doing, even if our trajectory in life has changed. Dwelling on past accomplishments and comparing them to our current situation can lead to frustration. Preserving our health and well-being involves recognizing our current abilities and maximizing them. The conversation highlights the challenges faced by athletes and individuals who experience physical decline as they age. It emphasizes the importance of not only considering the glory days but also the impact of injuries and the toll they take on overall quality of life. Despite the hardships, the majority of individuals involved in such situations still value the experiences and memories gained through their athletic endeavors, even if it means enduring physical limitations in the present.

    • The Power of Asking QuestionsAsking meaningful questions challenges the status quo and drives progress, making a positive impact on society. Curiosity and inquiry are powerful tools for making a difference.

      Asking the right questions can make a difference in the world. Peter Attia and Eric Chehab discussed how Peter's thought-provoking question about the first human to eat an avocado led to a meaningful discussion about making a change. They agreed that it's not always about having the right answers, but rather about asking important questions that challenge the status quo. Eric even shared how he recently told his kids that the people who truly make a difference are the ones with the questions, not necessarily the answers. This conversation highlights the power of curiosity and inquiry in driving progress and making a positive impact on society.

    • The Amusement and Challenges of Wearing Fake TeethBalancing self-expression and social appropriateness is crucial when engaging in unconventional behavior, as it can impact others and potentially lead to awkwardness and discomfort.

      Wearing fake teeth can be a source of amusement and social experimentation, but it may also create discomfort and frustration for those around you. Peter Attia shares his obsession with wearing fake teeth and the social experiments he conducted with them, even convincing people at his workplace that there were two identical twin doctors. He emphasizes the realism of these fake teeth and encourages others to try them for amusement. However, his wife pleaded with him not to wear them when meeting her family for the first time, highlighting the potential awkwardness and challenges that can arise from such unconventional behavior. Ultimately, the takeaway is that while unique experiences can be entertaining, it is important to consider the impact on others and find a balance between self-expression and social appropriateness.

    • Overcoming Insecurities Through Self-AcceptanceOur insecurities are often exaggerated in our own minds, and embracing who we are can lead to more genuine connections with others.

      Our personal insecurities can often be blown out of proportion in our own minds. In Peter Attia's experience, his self-consciousness about his teeth caused him to feel like a second-class citizen and impacted his interactions with others. However, when he finally revealed the truth about his teeth, he discovered that people's reactions were not as extreme as he had imagined. In fact, many people hadn't even noticed or paid much attention to it. This story highlights the importance of self-acceptance and not letting our insecurities hold us back. It reminds us that often, we are our own harshest critics, and that embracing who we are can lead to more genuine connections with others.

    • Improving Lifespan and Quality of Life Through Orthopedic SurgeryOrthopedic surgery focuses on maintaining and enhancing the quality of life for patients, allowing them to live their lives to the fullest with the help of knowledgeable and influential surgeons.

      Orthopedic surgery is a profession that focuses on improving health span rather than just extending lifespan. While many areas of medicine prioritize prolonging life, orthopedics aims to maintain and enhance the quality of life for patients. This profession allows surgeons like Eric Chehab to have a privileged view into people's lives and make a significant impact. By adopting principles advocated by influential figures like Peter Attia, orthopedic surgeons can help patients cope with conditions and injuries, enabling them to live their lives to the fullest. Although not everyone may have access to an orthopedic surgeon like Chehab, this conversation provides individuals with valuable insights to evaluate and engage with their own doctors.

    Recent Episodes from The Peter Attia Drive

    #317 ‒ Reforming medicine: uncovering blind spots, challenging the norm, and embracing innovation | Marty Makary, M.D., M.P.H.

    #317 ‒ Reforming medicine: uncovering blind spots, challenging the norm, and embracing innovation | Marty Makary, M.D., M.P.H.

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    Marty Makary, a Johns Hopkins surgeon and New York Times bestselling author, returns to The Drive to discuss his latest book, Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health. In this episode, Marty explores how a new generation of doctors is challenging long-held medical practices by asking critical new questions. He discusses the major problems of groupthink and cognitive dissonance in the medical community and delves into several of the "blind spots" raised in the book, including treatments for appendicitis, the peanut allergy epidemic, misunderstandings about HRT and breast cancer, antibiotic use, and the evolution of childbirth. He explains the urgent need for reform in medical education and the major barriers standing in the way of innovative medical research. Throughout the conversation, Marty offers insightful reflections on where medicine has succeeded and where there’s still room to challenge historic practices and embrace new approaches.

    We discuss:

    • The issue of groupthink and cognitive dissonance in science and medicine [2:30];
    • How a non-operative treatment for appendicitis sheds light on cognitive dissonance [7:00];
    • How cognitive dissonance and effort justification shape beliefs and actions [13:15];
    • How misguided peanut allergy recommendations created an epidemic [17:45];
    • The enduring impact of misinformation and fear-based messaging around hormone replacement therapy allegedly causing breast cancer [25:15];
    • The dangers of extreme skepticism and blind faith in science, and the importance of understanding uncertainty and probability [28:00];
    • The overuse of antibiotics and the rise of antibiotic resistant infections and poor gut health [33:45];
    • The potential correlations between early antibiotic use and chronic diseases [40:45];
    • The historical and evolving trends in childbirth and C-section rates [50:15];
    • Rethinking ovarian cancer: recent data challenging decades of medical practice and leading to new preventive measures [1:05:30];
    • Navigating uncertainty as a physician [1:19:30];
    • The urgent need for reform in medical education [1:21:45];
    • The major barriers to innovative medical research [1:27:30];
    • The dogmatic culture of academic medicine: why humility and challenging established norms are key for progress [1:38:15];
    • The major successes and ongoing challenges of modern medicine [1:51:00]; and
    • More.

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    The Peter Attia Drive
    enSeptember 16, 2024

    #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

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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.

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    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

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    Episode 65: A Cosplayer's Edgy Middle School Dream (ft. Fruitcake)

    Episode 65: A Cosplayer's Edgy Middle School Dream (ft. Fruitcake)

    Cosplay is one of the great pillars of nerd culture and we got the opportunity to interview a special guest who turned her passion into a career! Thank you to Vanessa De Galicia aka Fruitcake for joining us this week and answering our questions about the cosplay industry. Check out her Twitter and Twitch stream if you've ever wanted to cosplay! We also got excited about the new Death Note One Shot Special and how we're all attending LVLUP EXPO 2020!

    This week's question: Have you ever lost friends or drifted apart from people who didn't share the same nerdy interests?

    We'd love to hear if you have any recommendations for things to check out or comments on how to improve the show. You can also find us on Spotify, Itunes, Google Play, Youtube, Stitcher or our website! If you want a shout out on the show, post a nerd question in the comments or in our discord server and you might get added to the nut jar! Want to help produce the show? Visit our Patreon and consider becoming a patron!

    Music: www.purple-planet.com

    Vibing with Indie Music Artist Kingsley | Bringing the World Joy

    Vibing with Indie Music Artist Kingsley | Bringing the World Joy
    Today on Adeptus On-Air, host Michael Hoffman chats with Kingsley, an indie music artist, entrepreneur, and beauty mogul. Kingsley shares how she forged her path in college, intertwining a double major in business and vocal performance, refusing to limit her talents. From establishing herself as a Marketing Guru in Oregon to navigating the challenges of COVID, Kingsley shares her inspiring journey through thought-work and personal development to discover where she wanted to go with her career. Tune in for insights into Kingsley's entrepreneurial spirit, how she and Michael order the High School Musical movies, and a sneak peek into the process behind her upcoming album.

    Episode 107: A Deadly Final Season

    Episode 107: A Deadly Final Season

    So much news came out this week that was relevant for us so apologies in advance for information overload. This week Allen learned to read again with A Deadly Education by Naomi Novik. It's the most fun you'll have with a story we guarantee it! Sal insists you watch the final season of Attack on Titan. He recounts how he fell in love with the series and how rare it is for anime to actually finish. We hope you enjoy and stay safe out there!

    This week's question: What role and special abilities would you have if you were in a team shooter game?

    We'd love to hear if you have any recommendations for things to check out or comments on how to improve the show. You can also find us on Spotify, Itunes, Google Play, Youtube, Stitcher, or our website! If you want a shout out on the show, post a nerd question in the comments or in our discord server and you might get added to the nut jar! Want to help produce the show? Visit our Patreon and consider becoming a patron!

    Music: www.purple-planet.com

    Episode 115: Fantasy Out, Sci-fi In

    Episode 115: Fantasy Out, Sci-fi In

     

    Unfortunately we have to say good-bye to an anime that we didn't appreciate while it was with us. Sal laments the cancellation of Black Clover, a shonen anime that turned out was amazing. An old friend is coming back to us. Allen guiltily gushes about the new Mass Effect: Legendary Edition. He can't wait to see Garrus and Tali again. Stay safe out there folks!

    This week's question: Who are some of your favorite video game companions?

    We'd love to hear if you have any recommendations for things to check out or comments on how to improve the show. You can also find us on Spotify, Itunes, Google Play, Youtube, Stitcher, or our website! If you want a shout out on the show, post a nerd question in the comments or in our discord server and you might get added to the nut jar! Want to help produce the show? Visit our Patreon and consider becoming a patron!

    Music: www.purple-planet.com

     

    Episode 103: Mistbusters!

    Episode 103: Mistbusters!

    Who you gonna call? Mistbusters! This week Sal introduced us to the crazy world of Mistborn by Brandon Sanderson. It features one of the most interesting and well thought out magic systems that Sal has ever encountered! Following that up, Allen jumped aboard the Phasmophobia hype train from Kinetic Games. Ghost hunting has never been more fun and accessible! We hope you enjoy and stay safe out there!

    This week's question: What is your kryptonite?

    We'd love to hear if you have any recommendations for things to check out or comments on how to improve the show. You can also find us on Spotify, Itunes, Google Play, Youtube, Stitcher, or our website! If you want a shout out on the show, post a nerd question in the comments or in our discord server and you might get added to the nut jar! Want to help produce the show? Visit our Patreon and consider becoming a patron!

    Music: www.purple-planet.com

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