Logo
    Search

    #61 - Rajpaul Attariwala, M.D., Ph.D.: Cancer screening with full-body MRI scans and a seminar on the field of radiology

    enJuly 08, 2019

    Podcast Summary

    • The Revolutionary MRI Technology: Transforming Cancer ScreeningRaj Atariwala's innovative MRI technology has the potential to revolutionize cancer screening, making it essential for patients and healthcare professionals to consider its benefits.

      There is a revolutionary MRI technology developed by Raj Atariwala that has significant implications for cancer screening. The conversation begins with a discussion about the goal of translating the science of longevity into accessible content for everyone. Raj is introduced as a dual board certified radiologist and nuclear medicine physician who has been creating a new way of doing MRI by fine-tuning the hardware and building unique software. The conversation then delves into the history of radiology, explaining the different imaging technologies and their evolution. The second half of the episode focuses on cancer screening and the importance of MRI for detecting and monitoring cancer. This highlights the significance of Raj's MRI technology and its potential to improve cancer screening methods. The key takeaway is that this advanced MRI technology has the potential to revolutionize cancer screening and should be considered by patients and healthcare professionals.

    • The Fusion of Technology and Medicine in Advancing Preventative Care and Understanding the Human BodyThe combination of technology and medicine allows for advancements in preventative care and a deeper understanding of the human body, empowering patients to take control of their health.

      Prenuvo, a company affiliated with AIM, aims to empower patients by giving them access to preventative medicine. The discussion also highlights the importance of understanding medical scans and the risks and benefits associated with them. It is mentioned that many radiologists come from engineering backgrounds, as radiology involves a lot of technology. The conversation further delves into the speaker's personal journey from engineering to biomedical engineering to eventually pursuing a medical degree to better understand the language and complexities of medicine. The speaker's engineering mindset and thirst for knowledge led them to explore and advance the understanding of the body's processes and pathologies. In summary, the key takeaway is that the fusion of technology and medicine can lead to advancements in preventative care and a deeper understanding of the human body.

    • The Power of Combined Imaging Technologies in MedicineThe fusion of functional and anatomical imaging technologies like PET-CT enables doctors to make more accurate diagnoses and treatment plans, improving patient outcomes. Collaboration between surgeons and radiologists is crucial in maximizing the benefits of these techniques.

      Technology in the field of medicine, specifically radiology and nuclear medicine, has advanced to provide a better understanding of the human body. The combination of functional imaging and anatomic imaging through technologies like positron emission tomography and CT scans (PET-CT) has proven to be more powerful than each modality individually. This fusion of imaging technologies allows medical professionals to not only see the structure and shape of organs but also observe their functionality and metabolic activity. By incorporating both anatomical and functional information, doctors can make more accurate diagnoses and treatment plans. The collaboration between surgeons and radiologists is essential in maximizing the benefits of these imaging techniques and improving patient outcomes.

    • Understanding Radiation Exposure in Imaging TechniquesPatients should be informed about the varying levels of radiation in imaging techniques and make informed decisions about the necessity of undergoing certain tests to minimize potential risks.

      Different imaging techniques have varying levels of radiation exposure, and understanding the potential damaging effects of ionizing radiation is crucial. X-rays, CT scans, and PET CT scans all involve radiation, but the amount varies. The unit of measurement for radiation is millisieverts, which records the amount of energy deposited in the body. It is important to note that radiation is neither created nor destroyed, but it is transferred and can cause damage if it deposits in the body. Therefore, patients should be aware of the potential risks associated with radiation exposure and make informed decisions about the necessity of undergoing certain imaging tests.

    • Understanding Radiation Exposure in Medical Imaging ProceduresDifferent medical imaging procedures, such as PET-CT scans and nuclear medicine scans, involve varying levels of radiation exposure. It is crucial to consider cumulative exposure and potential implications on normal physiology for long-term health.

      Different medical imaging procedures involve varying levels of radiation exposure. The PET-CT scan, which combines positron emission tomography (PET) and computed tomography (CT), emits high-energy radiation with a significant amount of energy. When radioactive glucose is used in a whole body PET-CT scan, the radiation dose can reach up to 12 millisieverts in the US. On the other hand, nuclear medicine procedures involve injecting radioactive materials, resulting in radiation exposure throughout the entire body. To maximize the information obtained from the radiation exposure, nuclear medicine scans capture images of various body parts. It's important to consider the cumulative radiation exposure from all sources, including background radiation and other factors like altitude and travel routes. The aim is to limit long-term exposure and understand the potential implications on normal physiology based on historical incidents and research.

    • The Importance of Understanding Radiation Risks, Interpretation, and Imaging Modalities in MedicineKnowing the potential risks of radiation, the complexity of interpreting x-rays, and the benefits of different imaging modalities is crucial for making informed medical decisions.

      Radiation from CT scanners can have damaging effects, especially for younger individuals and females. The risk of cancer induction from CT scanners is greater in younger people, and females are more sensitive to radiation compared to males. This knowledge is crucial in pediatric medicine, where efforts are made to minimize radiation exposure in children. Additionally, the conversation highlights the complexity of interpreting x-rays, as the human body is not two-dimensional. X-rays require skilled radiologists to extract three-dimensional information from a two-dimensional image. The advent of CT scans revolutionized medical imaging by providing three-dimensional views, aiding in surgical planning and diagnosis. Understanding the potential risks and limitations of different imaging modalities is vital in medical decision-making.

    • The Evolution and Benefits of CT Scans in Medical ImagingCT scans revolutionized medicine by providing comprehensive, three-dimensional imaging of internal structures. The technology has evolved over time, with improved speed and resolution, allowing for more detailed images. However, higher slice numbers may require higher radiation doses.

      CT scans are a more advanced form of imaging compared to x-rays. While x-rays provide a single flash image, CT scans use a searchlight-like approach, capturing images from all angles around the body. The equipment measures how intensity passes through multiple layers, allowing a comprehensive evaluation of internal structures. Similar to how police officers use CT scans to determine the location of occupants in a building, CT scans use triangulation by rotating 360 degrees. The first CT scan was introduced by EMI in the 70s, revolutionizing medicine through its three-dimensional imaging capabilities. CT scanners have evolved in terms of speed and resolution, with earlier models being less efficient. Higher slice numbers or thinner slices provide more detailed images but may require higher radiation doses to overcome background noise.

    • Understanding the Factors and Techniques Behind CT Scan Slices, Contrast Material, and CalibrationThe number of slices in a CT scan is determined by organ movement, while contrast material and calibration help enhance visibility and accuracy in imaging.

      The number of slices in a CT scan, such as 256 or 512, is determined by the speed, resolution, and radiation requirements of the specific organ being scanned. For rapidly moving organs like the heart, a higher number of slices may be needed. However, for anatomically complicated but non-moving organs like the pancreas, even as few as eight slices can provide sufficient detail, as long as the patient can hold their breath and there's minimal movement. Additionally, contrast material, usually iodine-based, is often used in CT scans to help highlight blood vessels and enhance the visibility of organs. This contrast material creates a contrast effect by making certain structures appear white on the CT scan image, allowing for improved anatomical detail. Calibrating the CT scan involves using Hounsfield units, which range from -1000 to 2000, to measure tissue differences and provide more accurate imaging.

    • Comparing CT Scans and Ultrasounds: Strengths and Limitations in Medical Imaging TechniquesKnowing the strengths and limitations of CT scans and ultrasounds helps medical professionals select the most suitable imaging technique for different situations and patient needs.

      Medical imaging techniques like CT scans and ultrasounds have different strengths and limitations. CT scans provide detailed anatomical information and can be quickly performed, making them ideal for trauma patients. However, they involve radiation exposure. On the other hand, ultrasounds use high-frequency sound waves to penetrate tissue and create images based on echoes. They do not involve radiation and are particularly useful for examining the vasculature. However, ultrasounds may not provide as much detailed information as CT scans and may have limitations in terms of tissue penetration. Understanding the capabilities and limitations of these imaging techniques allows medical professionals to choose the most appropriate tool for each situation.

    • Understanding Ultrasound Technology and its Limitations in Medical ImagingUltrasound technology uses reflections to provide information about tissues, but it has lower resolution and challenges with air-filled areas. Skill and experience are needed for interpretation and different patient body types should be considered.

      Ultrasound technology works by using reflections to determine the depth and composition of tissues. It is similar to standing in a mountain range and hearing echoes to determine distance. Animals like bats and dolphins have exceptional ultrasound abilities, with dolphins even rivaling our finest medical equipment in resolution. Ultrasound is safe and does not increase the risk of cancer, unlike frequent CT scans. However, ultrasound has limitations, such as lower resolution and difficulties in imaging air-filled areas. Skill and experience play a crucial role in interpreting ultrasound images, and dealing with different patient body types is also important. Ultrasound is also used to visualize the heart, once an appropriate window is found to avoid interference from air in the lungs.

    • The Importance of Echocardiograms in Trauma CentersEchocardiograms, specifically transesophageal echocardiograms, play a critical role in trauma centers by providing detailed views of the heart and helping determine the need for immediate surgery. Accuracy in detecting pericardial fluid is crucial for patient safety.

      Echocardiograms, especially transesophageal echocardiograms, provide detailed views of the heart and are crucial in medical settings like trauma centers. Echocardiograms use ultrasound to visualize the heart's valves, walls, and blood flow. The proximity of the esophagus to the heart allows for excellent detail in images. In trauma situations, echocardiograms help determine if a patient needs immediate surgery by detecting abdominal and pericardial fluid, which are surgical emergencies. However, identifying different types of fluid can be difficult, and sometimes follow-up CT scans are necessary for confirmation. Ensuring accuracy is crucial as missing even a small amount of pericardial fluid can be a life-threatening injury.

    • The importance of clinical skill and imaging technology in diagnosing medical conditions, with a focus on mammography for breast cancer screening.Mammography is effective in detecting calcifications in fat tissue, but additional imaging techniques may be needed for women with dense breast tissue to ensure accurate diagnosis.

      Clinical skill and imaging technology, such as mammography, play a crucial role in diagnosing medical conditions quickly and efficiently. Mammography, which is a lower attenuation x-ray, is primarily used for screening breast cancer. It is effective in detecting calcifications in fat tissue, but it can be challenging to see through dense glandular tissue. In some women, glandular tissue does not get replaced with fat, resulting in dense breast tissue. For women with dense breast tissue, a mammogram may not be sufficient, and additional imaging modalities like ultrasound or MRI may be required to examine the tissue more thoroughly. Sensitivity and specificity of mammograms are generally high, but it is important to consider individual variations and potentially complement mammography with other imaging techniques for accurate diagnosis.

    • The Role of Sensitivity and Specificity in Mammogram AccuracyMammograms are not always reliable for detecting breast cancer, and their accuracy depends on factors such as breast density. Relying solely on one test may not provide accurate results, so individualized screening approaches are necessary.

      Mammograms are not always reliable for detecting breast cancer, and their effectiveness depends on factors such as breast density. Sensitivity and specificity play crucial roles in determining the accuracy of mammograms. Sensitivity refers to the ability to correctly identify true positive cases of breast cancer, while specificity refers to the ability to correctly identify true negative cases. The higher the sensitivity, the lower the chances of missing a cancer diagnosis, whereas higher specificity reduces false positive results. Mammograms have low sensitivity on dense breasts and higher sensitivity on fatty tissue breasts. It is important to understand that relying solely on one test, especially one that has low sensitivity and specificity, may not provide accurate results. Thus, individualized approaches to breast cancer screening are essential.

    • The Impact of Machine Learning and AI in MammographyMachine learning and AI can enhance the accuracy of mammography, but challenges include individual variability, the need for large amounts of standardized data, and potential limitations of backward-looking data. Molecular breast imaging (MBI) is an alternative test, but it may have high radiation exposure.

      Machine learning and AI have the potential to greatly impact the field of radiology, particularly in the area of mammography. Companies are already working on using machine learning techniques to assist radiologists and improve the sensitivity and specificity of mammography. However, achieving high levels of accuracy, such as 97-98%, is challenging due to individual variability and the uniqueness of each mammogram. Machine learning algorithms require large volumes of data reproduced in the exact same way to improve accuracy. Additionally, while mammography technology has advanced over the years, the data available for analysis is often backward-looking. Another alternative test called molecular breast imaging (MBI) exists, but it involves injecting a radioactive material and may have high radiation exposure.

    • The evolution of MRI technology: From accidental discovery to advanced medical diagnosticsMRI technology, originally discovered accidentally, has evolved into a complex system that utilizes physics to analyze the composition of materials, providing valuable insights into the human body.

      MRI technology was not initially developed for imaging purposes, but rather discovered accidentally while studying the effect of electromagnetic waves on materials. The MRI machine is an engineered delight and a more complicated set of physics compared to other imaging technologies. It is an evolved version of the NMR (nuclear magnetic resonance) machine used in organic chemistry. Understanding how an MRI works requires diving into physics. It is able to analyze the composition of materials, particularly hydrogen atoms, by detecting the behavior of protons. MRI technology has greatly advanced medical diagnostics and imaging capabilities, providing valuable insights into the human body.

    • The Relationship between Hydrogen and Protons in NMR and MRIMRI uses the detection of hydrogen nuclei, also known as protons, to visualize soft tissues in the human body, and the strength of the MRI magnet determines the quality of the images.

      Hydrogen and proton are used interchangeably in the context of NMR (Nuclear Magnetic Resonance) spectroscopy and MRI (Magnetic Resonance Imaging). In NMR, the behavior of the hydrogen nucleus is different when it is bound to oxygen or carbon, resulting in different wavelengths. MRI essentially detects hydrogen nuclei, which are protons, making it a hydrogen imager. Since the human body contains a significant amount of hydrogen in the form of water, fats, and proteins, MRI can visualize soft tissues. The strength of the MRI magnet, measured in Tesla, is crucial in orienting the hydrogen molecules in one direction. Higher Tesla fields enable better alignment of hydrogen, leading to clearer imaging.

    • The Technology Behind MRI MachinesMRI machines use a constant magnetic field and superconducting wire to generate images, requiring continuous cooling and backup power. Strong fields can stimulate nerve impulses, and MRI scans can be time-consuming.

      MRI machines rely on a constant magnetic field and superconducting wire to generate images. The magnet in an MRI is always on because the magnetic field needs to be present for the orientation of the imaging process. The superconducting wire runs just above absolute zero degrees Kelvin and requires continuous cooling to maintain this temperature. Backup power is necessary to ensure the continuous circulation of liquid helium around the wire. The direction of the magnet's orientation is generally facing away from the control center, and the right-hand rule indicates the direction of power flow in the coil. While the magnetic field itself may not cause harm, strong fields can stimulate nerve impulses and trigger symptoms like twitching and temporary headaches. MRI scans can also take a long time, especially for specific areas like the abdomen, due to the complexity of the imaging process.

    • Understanding MRI Imaging Techniques and ParametersMRI imaging techniques like T1-weighted and T2-weighted images capture specific elements using different parameters. T1-weighted images show only fat, while T2-weighted images show both fat and water. The acquisition time varies due to the slower water signal capture, and different MRI sequences have specific purposes.

      MRI imaging techniques, such as T1-weighted and T2-weighted images, rely on different parameters to capture specific elements and provide detailed information. In a T1-weighted image, only fat is visible, giving it a bright appearance. On the other hand, a T2-weighted image shows both fat and water, with water appearing brighter. The time it takes to acquire these images differs due to the echo time (TE) required to capture the water signal, which is slower than fat. Additionally, the repetition time (TR) for each sequence depends on the machine and needs to be customized. Furthermore, there are various MRI sequences, such as conventional spin echo, each with their own acronyms and purposes in capturing specific signals.

    • Techniques and Concepts in MRI ImagingUnderstanding gradient imaging, echoplanar imaging, and Fourier domain is crucial for radiologists in MRI. MRI sequences are conducted in 2D along different planes for comprehensive evaluation of body parts.

      MRI imaging involves various techniques and concepts such as gradient imaging, echoplanar imaging, and Fourier domain. The use of gradients allows for faster imaging by repulsing the signal before complete relaxation, with repulsing times as quick as two milliseconds. Additionally, echoplanar imaging enables the simultaneous visualization of multiple slices of the body by applying different fields. The Fourier transform is utilized to analyze the repetitive sine waves generated by the MRI pulses, plotting them in frequency and phase domains. Understanding these concepts is essential for radiologists in the field of MRI, although it may be challenging for individuals without a background in mathematics and physics. When evaluating different body parts like the knee, back, or head, MRI sequences are conducted in two dimensions along various planes to obtain the required information.

    • The benefits of MRI technology in diagnosing and detecting potential health issues in the body.MRI technology allows doctors to see detailed anatomical structures and detect conditions like aneurysms early, which can be life-saving.

      MRI technology allows doctors to see detailed anatomical structures and detect potential problems in the body, such as edema. By using different sequences and techniques, MRI can provide clear images of blood vessels, which is particularly useful in diagnosing issues in the brain. MRI's ability to excite blood flowing in specific directions and differentiate between oxygenated and deoxygenated blood allows for advanced imaging techniques like susceptibility weighted imaging. Additionally, the conversation highlights the importance of MRI in detecting conditions such as aneurysms, which can be treated electively to prevent life-threatening ruptures. The mortality rate for a ruptured aneurysm is extremely high, emphasizing the significance of early detection through MRI scans.

    • The Importance of Early Detection and Accessibility in Imaging Technologies for Saving LivesEarly detection through imaging technologies like MRA can help identify brain aneurysms, despite challenges such as cost and insurance coverage. Affordable and accessible imaging options are needed.

      Early detection and imaging technologies like Magnetic Resonance Angiography (MRA) can play a crucial role in saving lives by identifying potentially lethal conditions such as brain aneurysms. The conversation reveals that approximately 0.8% of the population may have an aneurysm in their brain, which is a higher prevalence than expected. Moreover, it highlights the potential genetic component of aneurysms, as finding one in a family often leads to other family members seeking screenings. However, the conversation also presents challenges, such as the high cost of MRA scans in the United States and the difficulty in convincing insurance companies to cover the expenses. Overall, the conversation emphasizes the importance of early detection and the need for more accessible and affordable imaging options.

    • Size isn't everything: Optimizing the effectiveness of hospital magnets.It's not about the size of the magnet, but how it's optimized and tuned. Understanding the physics and engineering is key to maximizing MRI machine performance.

      The size of a magnet used in hospitals is not necessarily indicative of its effectiveness. While big shot hospitals may brag about their larger magnets, the conversation highlights how a smaller magnet, such as a 1.5 Tesla, can still produce excellent imaging results when properly optimized and tuned. The width of the wavelength emitted by the magnets plays a crucial role in penetration and visibility. It is essential to understand the physics and engineering behind MRI machines, adjusting the parameters to maximize signal-to-noise ratio for speed and detail. Just like in Formula One, where a smaller engine can be engineered to produce exceptional performance, the focus should be on optimizing and understanding the technology rather than blindly pursuing bigger magnets for bragging rights.

    • A Step-by-Step Approach to Problem Solving in MedicinePeter Attia's approach in medicine involves focusing on desired outcomes, collaborating with experts, and iteratively optimizing processes to address clinical problems effectively.

      Peter Attia, an engineer in medicine, approaches problems by focusing on what he wants to know and see, and then working backwards to figure out how to make it work. He collaborates with MRI physicists to understand the hardware and sequences needed to achieve his goals. He acknowledges the expertise of those who specialize in the specific field, just as a mechanic is consulted to make an engine perform at its best. Through this iterative process of testing and feedback, he optimizes for a comprehensive view of the body in nuclear medicine and snapshot imaging in radiology. His approach aims to address clinical problems, such as optimizing radioactivity dose and detecting diseases like cancer.

    • Enhancing Diagnoses: Peter Attia's Innovative MRI Machine Integrates Functional Nuclear Medicine and Radiology for a Holistic Assessment of HealthPeter Attia's MRI machine combines functional nuclear medicine and radiology, providing a comprehensive and detailed understanding of a patient's condition by bridging the gap between binary nuclear medicine results and statistical radiology tests.

      Peter Attia developed a customized MRI machine that combines functional nuclear medicine with radiology to provide more accurate and comprehensive diagnoses. By adding features that allow the movement of patients on the table, Attia was able to connect different body parts, such as the head, neck, chest, and abdomen. This innovative approach enables patients to receive a more holistic assessment of their health. Attia's machine also incorporates DWIBS, a technique that examines water motion within tissues and identifies areas with high cellular density, which may indicate the presence of abnormalities like tumors. By merging functional and anatomical imaging, this MRI machine offers a more precise and detailed understanding of a patient's condition, bridging the gap between binary nuclear medicine results and the statistical nature of radiology tests.

    • Advanced Imaging for Accurate Cancer DetectionA combination of anatomic and functional imaging techniques provides detailed information about the presence of cancer, allowing patients to make personalized decisions about screening and take appropriate actions for peace of mind.

      A combination of anatomic and functional imaging can accurately identify cancer with minimal risk. The advanced diagnostic pathway used in this approach provides detailed information about the presence of cancer, allowing patients to make personalized decisions about screening. While false positives can occur, resulting in potential physical and emotional harm, the overall accuracy and effectiveness of this technology outweigh the risks. Sensitivity and specificity are crucial considerations, with the focus being on organ-specific detection. By using this approach, doctors can determine if a problem exists, providing patients with peace of mind and the ability to take appropriate actions. This technology has proven its success in identifying cancer, even in rare cases such as male breast cancer.

    • The Consequences of False Negatives in Medical ScreeningsFalse negatives in medical screenings can have both physical and emotional consequences for patients, highlighting the need for thorough medical histories and accurate screening techniques. Healthcare providers must communicate the limitations and potential risks of screening tests to patients.

      False negatives can occur in medical screenings, leading to potential harm for patients. In the case discussed, both a man and a woman had abnormalities in their breasts that were not detected by commonly used imaging tests. The man experienced emotional distress and had to undergo a biopsy, while the woman had a seatbelt injury that caused a scar and trapped fluid. These cases highlight the importance of thorough medical histories and proper screening techniques. False negatives can result in delayed diagnosis or unnecessary procedures, impacting both the physical and emotional well-being of patients. It is crucial for healthcare providers to consider the limitations of screening tests and to communicate the potential risks and benefits to patients.

    • The Value and Benefits of MRI Imaging in Detecting and Monitoring Conditions like Pancreatic CancerMRI imaging, with its contrast density and diffusion-weighted imaging, provides a comprehensive understanding of the body's internal conditions. It is a safer alternative to PET-CT scans, offering detailed tissue analysis for effective diagnosis and treatment planning.

      MRI imaging, specifically with the use of contrast density and diffusion-weighted imaging, is a valuable tool for detecting and monitoring conditions such as pancreatic cancer. By utilizing multiple filters and viewing organs from various angles, MRI can provide a comprehensive understanding of what's happening inside the body. Additionally, the creation of software tools that allow for efficient viewing of MRI images enhances the diagnostic capabilities. Compared to whole body PET-CT scans, which involve significant radiation exposure, MRI offers a safer alternative without compromising on the level of detail and tissue weighting. Overall, MRI is an effective and reliable imaging technique that combines functional imaging with detailed tissue analysis, providing a greater depth of information for diagnosis and treatment planning.

    • Advantages of MRI with DWI over PET-CT: Brain imaging, clear visualization of kidneys and bladder, revolutionizing prostate cancer diagnosis.MRI with DWI offers superior imaging of the brain, kidneys, bladder, and prostate, while PET-CT may miss details. It is also increasingly used for prostate cancer screening and raises possibilities for breast cancer detection.

      MRI with DWI has advantages over PET-CT in certain areas, such as the brain, kidneys, bladder, and prostate. MRI is known for being the best imager of the brain, while PET-CT may miss things in the brain due to its focus on glucose utilization. Additionally, the presence of glucose in the kidneys and bladder can make it difficult to see these organs clearly with PET-CT. On the other hand, DWI coupled with advanced molecular tests, like the 4K blood test, has revolutionized the approach to prostate cancer diagnosis. In countries like Europe and Australia, MRI with DWI is even used as a screening tool for prostate cancer. The conversation also raises the question of whether DWI could have a similar effect on breast cancer detection, highlighting the importance of both mammography and MRI for comprehensive screening.

    • The Importance of Standardization in MRI Imaging and Its Impact on Image Quality and InterpretationStandardization in MRI imaging is necessary to ensure consistent image quality and accurate interpretation of results. The lack of standardization poses challenges for both patients and healthcare professionals, but efforts are being made to standardize signal-to-noise levels and improve imaging quality across different machines.

      Standardization is crucial in MRI imaging. Unlike CT scans, which have standardized calibration units, MRI machines lack standardization, leading to inconsistent image quality and potential misinterpretation of results. The lack of standardization poses a challenge for both patients and healthcare professionals, as it requires expertise to differentiate between different scanners and ensure optimal imaging quality. The Quantitative Imaging Biomarkers Alliance (QIBA) is working towards standardizing MRI signal-to-noise levels across different machines, with the goal of ensuring uniform image quality regardless of the scanning location. This standardization is especially important for newer and powerful MRI sequences like diffusion weighted imaging (DWI), which can be as effective as contrast-enhanced breast MRI when performed correctly. Implementing standardization measures will help patients make informed decisions and ensure accurate diagnoses.

    • The Need for Standardization in MRI: Collaboration, Language Barriers, and Advancements in TechnologyStandardization in MRI is essential to eliminate confusion and misinformation for patients. Collaboration between physicists and radiologists, overcoming language barriers, and advancements in technology can improve efficiency and comfort during MRI scans.

      There is a need for standardization in the field of MRI in order to make it more effective and efficient. The lack of standardization has led to confusion and misinformation for patients seeking MRI scans. Collaboration between physicists and radiologists is crucial to achieve standardization, but language barriers often hinder this collaboration. The conversation also highlights the potential for advancements in MRI technology, specifically in terms of speed and computational power. With faster computers, it is possible to reduce the scanning time for patients, making it more comfortable and convenient. Additionally, the discomfort experienced during whole body MRI scans is due to the absorption of radio frequency energy, which leads to the heating of the body.

    • Advancements in Isotropic Imaging and the Challenges AheadIsotropic imaging techniques offer superior image quality and shorter scan times compared to conventional scanners, but there is a need to develop tools and software to accurately analyze whole-body images and train machines for reliable interpretation.

      Isotropic imaging, which allows for detailed examination of structures in three dimensions, is currently only possible with unconventional techniques and not readily available in commercial scanners. Conventional MRI scans cannot achieve isotropic imaging due to time constraints. The resolution deteriorates when conventional scans are rotated, resulting in distorted images. Dr. Attia's advanced imaging methods outperform even the best scanners in the country, providing superior image quality with shorter scan times. However, machine learning still has a long way to go in terms of analyzing whole-body images and accurately identifying organs. Developing tools and software for whole-body analysis will increase efficiency and help radiologists detect abnormalities more effectively while training machines to become reliable second readers.

    • Enhancing Radiologists' Efficiency through Machine Learning and CollaborationMachine learning can streamline the detection of abnormalities in repeat scans, saving time and minimizing missed findings. Continuous education and collaboration are crucial for improving patient care in the medical field.

      Machine learning can significantly improve the efficiency of radiologists in detecting differences in repeat scans. By using a paired t-test and subtracting previous scans from new ones, the machine can highlight any significant changes or deltas, making it easier for radiologists to identify abnormalities. This not only saves time but also helps ensure that nothing is missed during the review process. Additionally, the conversation emphasizes the importance of continuous education and collaboration in the medical field. The speaker acknowledges the generosity of his colleague in sharing insights and appreciates the opportunity to learn and improve patient care.

    Recent Episodes from The Peter Attia Drive

    #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.

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    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.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    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.

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    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.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enJuly 15, 2024

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

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

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

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

    We discuss:

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

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enJuly 08, 2024

    #308 - AMA #61: Sun exposure, sunscreen, and skin health: relationship between sun exposure and skin cancer, vitamin D production, and photoaging, how to choose a sunscreen, and more

    #308 - AMA #61: Sun exposure, sunscreen, and skin health: relationship between sun exposure and skin cancer, vitamin D production, and photoaging, how to choose a sunscreen, and more

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    In this “Ask Me Anything” (AMA) episode, Peter delves into two topics that have generated a lot of questions over the years: skin cancer and sunscreen. He begins by exploring the basics of UV radiation, discussing its effects on vitamin D conversion, photoaging, and its role in skin cancer. He examines various skin types, discussing their implications for sun exposure and vitamin D levels, as well as how to determine where you fall on the skin type scale. He then delves into the various types of skin cancer, with a particular emphasis on melanoma, exploring its complex relationship with UV exposure and other contributing risk factors. Additionally, he covers tanning beds, the importance of early skin cancer detection through regular skin checks, and the often confusing topic of sunscreen. He explains how sunscreen affects UV radiation and skin cancer risk, what SPF levels to choose, the differences between organic and mineral sunscreens, and what to consider when selecting the best sunscreen for your needs.

    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 #61 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

    We discuss:

    • The impact of UV radiation on the skin [2:00];
    • Understanding solar UV: from the electromagnetic spectrum to skin health [3:45];
    • The role of sunlight in vitamin D production [8:30];
    • Factors contributing to vitamin D deficiency: insufficient UV exposure, magnesium levels, and more [9:45];
    • Sun exposure needs for different skin types, and the limitations of current studies in defining vitamin D deficiency [12:45];
    • The acute and long-term effects of excessive UV exposure: sunburn, photoaging, and the increased risk of skin cancer [15:30];
    • Types of skin cancer and associations with UV exposure [17:45];
    • The complex relationship between melanoma and UV exposure [22:15];
    • Why UV exposure alone doesn’t necessarily explain the risk for melanoma [25:15];
    • Other risk factors for melanoma [29:15];
    • Tanning beds and skin cancer risk [34:45];
    • Balancing sun exposure: benefits and risks [38:15];
    • Tattoos and sun exposure [40:30];
    • The importance of regular skin checks, dermatologists, and emerging technologies showing promise for early detection of cancer [41:45];
    • Self-skin checks: what to look for [46:30];
    • Prevalence of skin cancer and the importance of early detection [49:30];
    • Summary of the major risk factors for melanoma [54:15];
    • The role of sunscreen in reducing skin cancer risk [55:45];
    • How sunscreen works, the differences between chemical and mineral sunscreens, an explanation of SPF, and more [58:30];
    • How to determine the appropriate sunscreen SPF to use based on the UV index [1:04:45];
    • Choosing the right sunscreen for your individual needs [1:07:00];
    • The impact of water and perspiration on sunscreen effectiveness [1:12:00];
    • Chemical vs. mineral sunscreens: safety concerns and recommendations [1:14:00];
    • Concerns about hormone effects from chemical sunscreens [1:19:15];
    • Sunscreen summary: skin types, key considerations, recommended brands, and more [1:23:15]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enJuly 01, 2024

    #307 ‒ Exercise for aging people: where to begin, and how to minimize risk while maximizing potential | Peter Attia, M.D.

    #307 ‒ Exercise for aging people: where to begin, and how to minimize risk while maximizing potential | Peter Attia, M.D.

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    In this special episode, Peter addresses the common questions about starting or returning to an exercise routine over the age of 50. Individuals in this age group have frequently reached out with questions about whether it's too late to start exercising and often express concern over a lack of prior training, a fear of injury, or uncertainty about where to begin. Peter delves into the importance of fitness for older adults, examining all four pillars of exercise, and provides practical advice on how to start exercising safely, minimize injury risk, and maximize potential benefits. Although this conversation focuses on people in the “older” age category, it also applies to anyone of any age who is deconditioned and looking to ease into regular exercise.

    We discuss:

    • Key points about starting exercise as an older adult [2:45];
    • Why it’s never too late to begin exercising and incorporating the four pillars of exercise [5:45];
    • The gradual, then sharp, decline in muscle mass and activity level that occur with age [10:00];
    • The decline of VO2 max that occurs with age [15:30];
    • Starting a training program: exercise variability, movement quality, realistic goals, and more [18:30];
    • Improving aerobic capacity: the malleability of the system, the importance of consistency, and setting long-term fitness goals [25:15];
    • Starting cardio training: base building, starting with low volume, and zone 2 training [30:45];
    • The critical role of VO2 max in longevity [36:45];
    • How to introduce VO2 max training to older or deconditioned individuals [46:15];
    • Options for performing zone 2 and VO2 max training [53:45];
    • The ability to make gains in strength and muscle mass as we age [57:00];
    • How to implement strength training for older individuals [1:01:00];
    • Advice for avoiding injury when strength training [1:07:30];
    • Risk of falls: the devastating consequences and the factors that increase fall risk [1:12:15];
    • Mitigating fall risk: the importance of foot and lower leg strength, ankle mobility, and balance [1:19:45];
    • Improving bone mineral density through resistance training [1:24:30];
    • The importance of protein in stimulating muscle protein synthesis, especially in older adults [1:31:00];
    • Parting advice from Peter [1:34:00]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enJune 24, 2024

    #306 - AMA #60: preventing cognitive decline, nutrition myths, lowering blood glucose, apoB, and blood pressure, and more

    #306 - AMA #60: preventing cognitive decline, nutrition myths, lowering blood glucose, apoB, and blood pressure, and more

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    In this “Ask Me Anything” (AMA) episode, Peter provides insights on a broad range of important topics. He delves into the prevention of cognitive decline, the link between cardiovascular disease and Alzheimer's disease, and methods to lower blood glucose, insulin, and apoB. He also addresses nutrition-related queries, exploring the impact of dietary habits on weight loss and longevity, how a person can identify the best diet for themselves, and common nutrition myths. Additional discussions include optimal blood pressure, daily step goals, the benefits of standing versus sitting desks, and much more.

    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 #60 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

    We discuss:

    • Overview of topics and episode format [1:40];
    • Preventing cognitive decline [5:00];
    • How to lower blood glucose and insulin [13:30];
    • The relationship between lipids, CVD, and Alzheimer’s disease, and whether statins can increase the risk of neurodegenerative disorders and AD [23:15];
    • Reducing apoB levels through exercise and diet [31:45];
    • Pharmacological options for lowering apoB [38:00];
    • How nutrition impacts longevity via metabolic health, muscle mass, BMD and more [40:15];
    • How can someone determine the best diet for themselves? [43:45];
    • Nutrition myth: All weight loss is good [46:45];
    • Nutrition myth: Metabolic rates are dramatically different among individuals based on genetics [49:00];
    • Nutrition myth: Losing weight after a brief period of overeating is impossible [53:45];
    • Nutrition myth: GLP-1 agonists are a replacement for a healthy lifestyle [57:45];
    • Nutrition myth: There is a single best diet for weight loss [1:03:00];
    • Nutrition oversimplification: All calories are created equal [1:05:45];
    • Daily step goals [1:06:45];
    • The benefits of standing versus sitting throughout the day [1:10:45];
    • How to identify the most impactful and easiest-to-implement ways to improve your health [1:12:30];
    • The critical importance of emotional health [1:14:30];
    • Why supplements should be considered as supportive aids rather than primary solutions in one’s strategy to improve longevity [1:18:00];
    • Strategies for reducing high blood pressure [1:20:45];
    • Peter’s biggest frustrations with "mainstream health advice" [1:28:00];
    • Peter’s chaotic, yet cherished, morning routine [1:31:00]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enJune 17, 2024

    #305 ‒ Heart rate variability: how to measure, interpret, and utilize HRV for training and health optimization | Joel Jamieson

    #305 ‒ Heart rate variability: how to measure, interpret, and utilize HRV for training and health optimization | Joel Jamieson

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    Joel Jamieson is a conditioning expert who developed Morpheus to give people a smarter way to build their conditioning regimen and improve their recovery. In this episode, Joel dives deep into the world of heart rate variability (HRV), explaining its scientific foundation, how it measures the balance between the sympathetic and parasympathetic nervous systems, the various methods of measurement, and how it can guide healthier lifestyle choices and improved training performance. He explores the nuances of HRV calculation, the impact of aging on HRV, and the roles of genetics, exercise, and other lifestyle factors in this process. He also covers Morpheus, the innovative training tool that won Peter over after his initial skepticism, highlighting its practicality and effectiveness in guiding training and optimizing fitness outcomes.

    We discuss:

    • Heart rate variability (HRV): evolution, science, and practical applications of HRV in athletic training [4:00];
    • Methods of measuring HRV: EKG, wrist-based sensors, and more [11:30];
    • How HRV is calculated from the data [22:30];
    • The role of the autonomic nervous system (ANS) in regulating HRV [25:45];
    • The decline in HRV with age, and the mitigating effects of fitness and other lifestyle factors [33:30];
    • The role of genetics in HRV, the modifiability of HRV, and a comparison of VO2 max and HRV as predictors of mortality [37:00];
    • How aging affects HRV and sympathetic drive, and the importance of spontaneous movement and exercise in maintaining the body's adaptability [43:30];
    • How Morpheus measures HRV using RMSSD and normalizes it to a 100-point scale for easier interpretation [49:45];
    • The Morpheus system: development, integration with various metrics, and personalized daily training recommendations to optimize fitness and recovery [51:30];
    • The benefits of morning HRV readings for assessing daily readiness compared to overnight HRV measurements [1:03:00];
    • Why Morpheus recommends using a chest strap rather than an arm band [1:10:00];
    • The impact of consistent exercise, stress, alcohol, and other lifestyle factors on HRV [1:11:15];
    • Optimizing zone 2 training with Morpheus [1:18:15];
    • Using heart rate recovery (HRR) as an indicator of athletic conditioning and the balance between aerobic and anaerobic systems [1:22:45];
    • The importance of tracking HRV trends over time rather than focusing on data from a given day [1:29:00];
    • Effect of GLP-1 agonists on heart rate and HRV [1:34:45];
    • Where HRV belongs in the hierarchy of health metrics [1:42:00];
    • Parting thoughts [1:46:30]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enJune 10, 2024

    #304 – NEW: Introducing quarterly podcast summaries - Peter shares his biggest takeaways on muscle protein synthesis, VO2 max, toe strength, gut health, and more

    #304 – NEW: Introducing quarterly podcast summaries - Peter shares his biggest takeaways on muscle protein synthesis, VO2 max, toe strength, gut health, and more

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    In this quarterly podcast summary (QPS) episode, Peter introduces a new format aimed at summarizing his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from each episode, covering diverse topics such as protein and muscle building with Luc van Loon, toe strength with Courtney Conley, VO2 max with Olav Aleksander Bu, liquid biopsies for cancer with Alex Aravanis, gut health and probiotics with Colleen Cutcliffe, and road safety with Mark Rosekind. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these engaging discussions.

    If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the episode #304 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

    We discuss:

    • How Peter keeps track of his takeaways from each podcast episode [5:15];
    • Luc van Loon episode: fat utilization, muscle protein synthesis, dietary protein, aging and inactivity, and more [8:45];
    • Behavioral changes that have come about from the conversation with Luc van Loon [23:45];
    • Courtney Conley episode: importance of toe strength and the impact of dedicated foot training [26:45];
    • Olav Aleksander Bu episode: the importance of VO2 max for lifespan, and the practicalities of measuring and improving VO2 max [36:45];
    • Behavioral changes that have come about from the conversation with Olav [56:00];
    • Alex Aravanis episode: liquid biopsies for cancer detection [1:01:30];
    • Colleen Cutcliffe episode: the importance of gut bacteria balance, and the potential therapeutic uses of probiotics, particularly Akkermansia [1:16:45];
    • Mark Rosekind: the significant issue of road fatalities and injuries, their causes, and practical safety measures to reduce risks [1:27:00]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enJune 03, 2024

    #303 - A breakthrough in Alzheimer’s disease: the promising potential of klotho for brain health, cognitive decline, and as a therapeutic tool for Alzheimer's disease | Dena Dubal, M.D., Ph.D.

    #303 - A breakthrough in Alzheimer’s disease: the promising potential of klotho for brain health, cognitive decline, and as a therapeutic tool for Alzheimer's disease | Dena Dubal, M.D., Ph.D.

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    Dena Dubal is a physician-scientist and professor of neurology at UCSF whose work focuses on mechanisms of longevity and brain resilience. In this episode, Dena delves into the intricacies of the longevity factor klotho: its formation and distribution in the body, the factors such as stress and exercise that impact its levels, and its profound impact on cognitive function and overall brain health. Dena shares insights from exciting research in animal models showing the potential of klotho in treating neurodegenerative diseases as well as its broader implications for organ health and disease prevention. She concludes with an optimistic outlook for future research in humans and the potential of klotho for the prevention and treatment of Alzheimer’s disease.

    Disclosure: Peter is an investor in Jocasta Neuroscience, a company working to develop klotho as a therapy for people with Alzheimer’s disease.

    We discuss:

    • Dena’s fascination with aging and how she came to study klotho [3:30];
    • Biological properties of klotho: production, regulation, decline with age, and factors influencing its levels [11:45];
    • Potential benefits of klotho on brain health [22:00];
    • The relationship between soluble klotho protein, platelet factors, and cognitive enhancement [33:45];
    • The role of platelet factor 4 (PF4) and it’s interaction with GluN2B in mediating cognitive enhancement [46:45];
    • Benefits of klotho observed in a mouse model of Parkinson’s disease [55:45];
    • Benefits of klotho observed in a mouse model of Alzheimer’s disease [1:03:00];
    • Promising results of klotho in primate models, and the importance of finding an appropriate therapeutic dose before moving to human trials [1:08:00];
    • Speculating why a single klotho injection has such long-lasting effects [1:25:30];
    • Potential cognitive benefits of klotho in humans, the impact of the KL-VS genetic variant on klotho levels, and the need for human trials to confirm these effects [1:27:45];
    • The interaction between the KL-VS genetic variant and APOE4 and how it impacts risk of Alzheimer’s disease [1:34:45];
    • The significance of klotho levels: studies linking lower levels to increased mortality and the broader implications for organ health and disease prevention [1:47:15];
    • Measuring klotho levels and determining an individual’s KL-VS status [1:52:15];
    • The promising potential of klotho for Alzheimer’s disease treatment, and the importance of philanthropy for funding research [1:58:00]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enMay 27, 2024

    #302 - Confronting a metabolic epidemic: understanding liver health and how to prevent, diagnose, and manage liver disease | Julia Wattacheril, M.D., M.P.H.

    #302 - Confronting a metabolic epidemic: understanding liver health and how to prevent, diagnose, and manage liver disease | Julia Wattacheril, M.D., M.P.H.

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    Julia Wattacheril is a physician scientist and director of the Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) program at Columbia University Irving Medical Center. In this episode, Julia delves deep into the complex world of liver health, beginning with a foundational overview of liver physiology. She provides an in-depth look at how alcohol impacts liver function, breaking down the metabolism of ethanol and its detrimental effects. Julia then shifts the focus to understanding liver function tests and optimal enzyme levels, providing a detailed explanation of AST and ALT and elucidating why fluctuations in these levels may or may not be concerning. She provides a primer on the four major stages of liver disease, discussing risk and emphasizing the importance of early diagnosis. Julia highlights the role of liver disease in increasing the risk of cancer and cardiovascular disease and covers in detail the various strategies for diagnosing, treating, and preventing the progression of liver disease.

    We discuss:

    • Julia’s training, the importance of liver health, and the challenges and innovations of hepatology [3:15];
    • The complex and crucial functionality of the liver, its four most essential functions, and more [8:45];
    • Liver injuries: historical and evolving understanding of causal factors, and the progression to liver diseases and cancer [13:15];
    • How the liver metabolizes nutrients and what happens in the presence of excess calories or alcohol [24:45];
    • Methods of diagnosing liver disease and how insights guide treatment and management strategies [33:30];
    • The poisonous nature of ethanol to the liver [40:30];
    • Varied responses to alcohol, damaging effects of alcohol beyond the liver, and the process of advising patients on their alcohol consumption [47:15];
    • Understanding liver enzymes AST and ALT—interpreting levels, lifestyle factors that affect them, and diagnostic approaches [58:30];
    • Interpreting liver function tests for fatty liver disease, and the challenges of diagnosing liver pathologies, particularly in children versus adults [1:13:15];
    • Comprehensive liver health assessments via imaging and various diagnostic tools to prevent overlooking potential liver pathologies [1:18:45];
    • Potential impact of recreational drugs, statins, and other medications on liver function test results [1:26:45];
    • Shifting nomenclature from NAFLD to MASLD to reflect accuracy in the underlying pathophysiology and understanding of liver diseases [1:30:30];
    • Pathophysiology of MASLD, the need for proactive screening, and the significance of liver fat percentage as an indicator of metabolic health [1:36:30];
    • The importance of screening for rare conditions alongside common metabolic diseases associated with fatty liver accumulation [1:42:45];
    • Practical strategies for managing MAFLD [1:45:30];
    • The impact of fructose consumption on liver health and the challenges of disentangling its effects from other factors like obesity and insulin resistance [1:52:45];
    • The potential of GLP-1 agonists for the treatment of MASLD [1:57:45];
    • How the four stages of liver disease have evolved [2:00:30];
    • Increased cancer and heart disease risk associated with early-stage MAFLD [2:05:15];
    • Emerging drugs and therapies for addressing fat accumulation and fibrosis related to MAFLD [2:12:15];
    • Peter’s major takeaways [2:18:45]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enMay 20, 2024

    Related Episodes

    2021 Anne Klibanski Visiting Lecture Series 9 with Drs. Manisha Bahl and Yolanda Bryce

    2021 Anne Klibanski Visiting Lecture Series 9 with Drs. Manisha Bahl and Yolanda Bryce

    "Innovations in the Detection, Diagnosis, and Treatment of Breast Cancer"

    The Anne Klibanski Visiting Lecture Series was created to support and advance the careers of women. These lectures bring together faculty from institutions that have hosted Anne Klibanski Scholars with MGH scholars, on topics that overlap both research areas.

    Presenters:
    Manisha Bahl, MD, Breast Imaging Radiologist, Massachusetts General Hospital/Harvard Medical School presented on “Tomosynthesis, Contrast-Enhanced Mammography, and Artificial Intelligence to Improve the Detection and Diagnosis of Breast Cancer”
    Yolanda Bryce, MD, Director of Interventional Radiology Training Program, Memorial Sloan Kettering Cancer Center presented on “Cryoablation of Breast Cancer”

    Learning Objectives:
    Upon completion of this activity, participants will be able to:

    • Recognize the advantages of digital breast tomosynthesis and contrast-enhanced mammography over conventional digital 2D mammography.
    • Review interpretive and noninterpretive artificial intelligence applications for breast imaging.
    • Discuss justifications and approach for cryoablation of breast cancer.
    • Describe a potential role of cryoablation in boosting immune response.

    Webinar available: https://youtu.be/l1xsoDC6vM4

    How to interpret an abdominal CT

    How to interpret an abdominal CT
    TO VIEW PLEASE DOWNLOAD
    The CT scan has become central in the management of abdominal conditions, especially emergencies. But how do you interpret a CT when theres no radiologist around or you can't wait for the report? Pete Thurley tells Jon Lund the secrets of radiology and gives a structure to looking at CTs so that you never miss anything again. Essential viewing for all for both exams and real life!
    Pete Thurley is a Consultant Radiologist at the Royal Derby Hospital, UK and Jon Lund is Clinical Associate Professor of Surgery at the University of Nottingham,UK

    Episode 24: Women in Radiology - Interview with Dr. Elizabeth Kagan Arleo

    Episode 24: Women in Radiology - Interview with Dr. Elizabeth Kagan Arleo

    Dr. Lauren Burkard-Mandel hosts the women in radiology series for the podcast. In the third episode of the series, Dr. Burkard-Mandel speaks with Dr. Elizabeth Arleo, about her personal experiences, getting involved early in WIR groups, and the importance of work-life balance.

    aawr.org

    Dr. Arleo's book: First, Eat Your Frog: And Other Pearls for Professional Working Mothers.
    Amazon
    Bookshop

    Diversity in Radiology: Current Status and Trends Over the Past Decade. Wu et al. Radiology 2022; 305:640–647.

    Current Status of Diversity by Race, Hispanic Ethnicity, and Sex in Diagnostic Radiologyy. Chapman et al. Radiology 2014;270:232–240. 

    ACR Diversity Report. (2019)