174 episodes

Expert insight on health, performance, longevity, critical thinking, and pursuing excellence. Dr. Peter Attia (Stanford/Hopkins/NIH-trained MD) talks with leaders in their fields.

The Peter Attia Drive Peter Attia, MD

    • Medicine
    • 5.0 • 3 Ratings

Expert insight on health, performance, longevity, critical thinking, and pursuing excellence. Dr. Peter Attia (Stanford/Hopkins/NIH-trained MD) talks with leaders in their fields.

    Lauren Miller Rogen and Richard Isaacson, M.D.: Alzheimer’s disease prevention—patient and doctor perspectives

    Lauren Miller Rogen and Richard Isaacson, M.D.: Alzheimer’s disease prevention—patient and doctor perspectives

    Peter is joined by writer, director, actress, and founder of HFC, Lauren Miller Rogen, and previous podcast guest and director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian, Dr. Richard Isaacson. In this episode, Lauren tells the heartbreaking story of watching members of her family succumb to Alzheimer’s disease (AD) which motivated her to proactively address her own risk with Richard’s guidance. Richard discusses the various genetic and lifestyle factors that influence the risk of AD and uses Lauren’s unique situation to explain how he diagnoses patients and personalizes care. They go through Lauren’s protocol of preventative measures that have already produced marked results, and end with the uplifting message that one’s genetic predisposition does not seal one's fate.


    We discuss:
    Lauren’s deep family history of Alzheimer’s disease (3:10); The influence of genetics, epigenetics, and lifestyle on Alzheimer’s disease risk (13:45); Lauren’s mother’s disease progression and the enormous stress it causes for family members (24:30); The various manifestations of Alzheimer’s disease depending on the location of pathology (29:30); The three stages of Alzheimer's disease (34:45); Richard’s deep exploration into Lauren’s family history revealing clues about a diagnosis and a roadmap to successful disease mitigation (39:15); How exercise reduces Alzheimer’s disease risk, and the different risk between males and females (58:00); Why knowing your APOE status is important, and whether certain people should be wearier of head trauma (1:08:00); How Richard uses genetic testing to personalize care (1:14:45); The “ABCs” of Alzheimer’s prevention, lifestyle interventions, and Lauren’s personal protocol for reducing her risk (1:21:45); Unique treatment for people with the ApoE4 variant (1:36:30); Richard’s mixed opinion on CBD and THC as a tool for disease prevention (1:40:00); Cognitive testing procedures, and how Lauren’s tests furthered her commitment to her disease prevention protocol (1:41:45); The relevance of sense of smell and hearing in Alzheimer’s disease risk and prevention (1:50:00); The emotional benefit of knowing you have control over your mental and physical health (1:57:30); HFC—a charitable organization founded by Lauren and Seth (2:00:15); and More.

    Learn more: https://peterattiamd.com/

    Show notes page for this episode: https://peterattiamd.com/laurenmillerrogen-richardisaacson/ 

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    • 2 hrs 11 min
    Paul Offit, M.D.: An expert perspective on COVID-19 vaccines

    Paul Offit, M.D.: An expert perspective on COVID-19 vaccines

    Paul Offit is a pediatrician specializing in infectious diseases and an expert in virology and vaccine development. He currently serves on the FDA committee overseeing and evaluating COVID-19 vaccines. In this episode, Paul discusses the strategies and major companies pursuing a vaccine against the SARS-CoV-2 virus. He gets into the nuances of the vaccine approval process and its implications for COVID-19 vaccine outlook. Paul also explains potential risks, reveals his own confidence level in safety, and gives insight into protection against reinfection with vaccination. Please note that this episode was recorded 11/05/2020, prior to the 11/09/2020 news release of the Pfizer vaccine update.
     
    We discuss:
    How Paul’s experience as a child in a chronic care hospital as child informed his path in pediatrics and vaccine development (3:30); Addressing the anti-vaccination sentiment and explaining the fraudulent origins of the anti-vaccination movement (8:00); Lessons and insights from 26 years studying rotavirus and creating a successful rotavirus vaccine (17:00); Developing a new vaccine: the different phases of clinical trials, overall timeline, and financial costs (27:15); Operation Warp Speed: the expedited process of creating a coronavirus vaccine (32:30); Various vaccine strategies—RNA, DNA, virus vector—and the challenges associated (35:00); The Moderna and Pfizer mRNA vaccines: strategy, timeline, and Emergency Use Authorization (41:15); Paul’s confidence level in the safety of the first coronavirus vaccines (48:30); The risks associated with different types of vaccines, and updates on the Johnson & Johnson and Astrazeneca coronavirus vaccines (52:15); What we know about the coronavirus vaccines approved in Russia and China (55:45); The latest on the Merck coronavirus vaccine (57:15); The recombinant/purified protein vaccine approach for coronavirus—big players, risks, and the best vaccine for the elderly (57:45); Attenuated and inactivated vaccine strategies for coronavirus (1:02:00); The genetic drift of SARS-CoV-2: Impacts for protection and vaccine development (1:02:30); Paul’s take on the hypothesis that a previous coronavirus infection offers protection against the novel COVID-19 (1:06:45); Addressing the concern that antibodies fade over time (1:09:15); Blood type and protective against coronavirus (1:13:00); Distribution: the challenge of prioritizing the limited doses of vaccines after approval (1:13:15); Paul’s perspective on COVID-19 vaccine safety (1:16:15); Considerations regarding vaccinating children for coronavirus and the role of a fever immune response (1:21:45); Why vaccine development can be challenging and risks of current COVID-19 strategies (1:29:45); and More.
    Learn more: https://peterattiamd.com/

    Show notes page for this episode: https://peterattiamd.com/pauloffit 

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    • 1 hr 35 min
    AMA #17: Body composition methods tour de force, insulin resistance, and Topo Chico

    AMA #17: Body composition methods tour de force, insulin resistance, and Topo Chico

    In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss different methods to evaluate body composition. They explore ways of measuring body fat, delineating between subcutaneous and visceral fat, and go over best strategies for improving body composition and optimizing health. They also discuss insulin resistance using a patient case study that highlights interventions capable of reversing the condition. Finally, Peter addresses his level of concern about a recent Consumer Report finding that Topo Chico had the highest levels of a class of synthetic chemicals (PFAS) of all the carbonated bottled waters tested. Peter concludes by sharing if the finding will change his consumption habits. If you’re not a subscriber and 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 on our website at the AMA #17 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
     

    We discuss:
    Body mass index (BMI) vs. body fat percentage (BF%) (1:45); Methods of assessing body fat—Magnetic Resonance Imaging (MRI) (6:25); The different types of body fat (9:00); Methods of assessing body fat—Computed Tomography (CT Scan) (12:00); Methods of assessing body fat—Dual-Energy X-ray Absorptiometry (DEXA) (14:30); Methods of assessing body fat—Hydrostatic/Underwater Weighing (19:25); Methods of assessing body fat—Air Displacement (Bod Pod) (22:25); Methods of assessing body fat—Skinfold measurement (23:55); Methods of assessing body fat—Total Body Water (27:15); Methods of assessing body fat—Bioelectrical Impedance (BIA) (28:45); The optimal body fat percentage, muscle mass, and the best strategy to improve body composition (31:30); Defining insulin resistance and the steps to reverse it (40:15); Patient case study: Reversing insulin resistance (49:00); Addressing the recent finding of high levels of PFOA in Topo Chico (58:25); and More. Learn more: https://peterattiamd.com/

    Show notes page for this episode: https://peterattiamd.com/ama17 

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    • 18 min
    BJ Miller, M.D.: How understanding death leads to a better life

    BJ Miller, M.D.: How understanding death leads to a better life

    BJ Miller is a hospice and palliative care specialist on a quest to reframe our relationship with death. In this episode, BJ begins with how his own brush with death radically shifted his perspective and ultimately forged his path towards palliative care and helping patients integrate and understand their life in a meaningful way. BJ recounts several moving stories from his patients, which reveal important lessons about overcoming the fear of death, letting go of regret, and what’s most important in life. He discusses the major design flaws of a “death phobic” healthcare system. Furthermore, he makes the case that seeing death as a part of life allows us to live well, as opposed to living to evade death itself. He concludes with a discussion around physician-assisted death as well as his hopes around the use of psychedelics to reduce suffering in end-of-life care.
     
    We discuss:
    BJ’s accident leading to the loss of his limbs and his experience inside a burn unit [3:00]; Coping with his amputations—being tough, the grieving process, and the healing properties of tears [14:30]; Going from art history to medical school: the value of a diverse background in medicine [28:15]; How BJ’s new body liberated him [40:00]; How losing his sister to suicide and his disillusionment with medicine altered his path [47:15]; Discovering his path of palliative care—distinct from hospice—in medicine [55:30]; Our complicated relationship with death, and how acknowledging it can release its grip and improve living [1:02:15]; The different distinctions around the fear of death, and how BJ helps his patients negotiate fears [1:10:00]; The major design flaws of a “death phobic” healthcare system [1:14:15]; Common regrets, the value of time, and other insights from interactions with patients in their final moments of life [1:23:00]; The story of Randy Sloan—a case study of playing life out [1:33:45]; Physician-assisted dying: Legality and considerations [1:39:45]; The use of psychedelics in end-of-life care, and what BJ is most excited about going forward [1:45:45]; and More. Learn more: https://peterattiamd.com/

    Show notes page for this episode: https://peterattiamd.com/bjmiller 

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    • 1 hr 54 min
    James O’Keefe, M.D.: Preventing cardiovascular disease and the risk of too much exercise.

    James O’Keefe, M.D.: Preventing cardiovascular disease and the risk of too much exercise.

    James O’Keefe is a preventative cardiologist and bestselling author of The Forever Young Diet and Lifestyle. In this episode, James discusses cardiac physiology and what makes the human heart susceptible to disease. He provides evidence for what supports his approach to exercise--elucidating both positive and negative kinds of exercise for heart health. He also discusses the role of nutrition, specific nutrients, and pharmacological interventions to support heart and brain longevity.
     
    We discuss:
    James’ background and why he favors a preventative approach to cardiology [3:15]; Understanding atherosclerosis and the misconception that it’s a “plumbing problem” [10:15]; The danger in excessive exercise—a reverse J-shaped mortality curve [21:15]; The story of Micah True—A case study of excessive exercise [49:15]; The best kinds of exercise for longevity—The Copenhagen City Heart Study [53:00]; Being a more balanced athlete and finding the right exercise intensity [58:45]; Heart rate during exercise, resting heart rate, and other important metrics [1:04:00]; Nutrition for cardiovascular health [1:09:45]; Important nutrients: Magnesium, potassium, calcium, sodium, and collagen [1:19:30]; SGLT2 inhibition for diabetes, cardio-protection, and general longevity [1:24:15]; GLP-1 agonists for weight loss and reducing cardiovascular risk [1:34:15]; Statins—Mechanism of action, safety, and useful alternatives [1:37:25]; A 40-year view on cardiovascular risk, and the possibility of reversing arterial calcification [1:45:45]; Evidence for high dose EPA and DHA for the reduction of cardiovascular disease risk [1:53:30]; The impact of omega-3, curcumin, and other compounds on mental health and dementia [1:59:00]; James’ focus beyond cardiology [2:02:15]; and More. Learn more: https://peterattiamd.com/

    Show notes page for this episode: https://peterattiamd.com/JamesOKeefe 

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    • 2 hrs 9 min
    Vinay Prasad, M.D., M.P.H: Hallmarks of successful cancer policy

    Vinay Prasad, M.D., M.P.H: Hallmarks of successful cancer policy

    Vinay Prasad is a practicing hematologist-oncologist who doubles as a “meta-researcher,” studying the quality of medical evidence, health policy, and clinical trials. In this episode, Vinay discusses the differences in clinical treatment from the existing medical evidence, often leading to useless, or even harmful, outcomes for patients. With a focus in oncology, he takes a deep dive into the field’s structural problems, which include the disconnect between progress and funding, drug costs, and financial conflicts of interest. He concludes with his “six hallmarks of successful cancer policy” as a potential roadmap to sustained progress against cancer and a way to avoid repeating the policy and practice mistakes of the past.

     

    We discuss:

    Vinay’s background and unique perspective [3:15]; Medical reversal—the disconnect between research findings and clinical applications in medicine [10:15]; The uniquely challenging field of oncology [22:45]; The importance of bedside manner with cancer patients [30:00]; Structural problems in oncology—Problem #1: Huge costs for small improvements [37:00]; Structural problems in oncology—Problem #2: Medical reversal—when medical practices are adopted based on low levels of evidence [40:15]; Structural problems in oncology—Problem #3: Slow progress in cancer research (despite all the hype and propaganda) [45:00]; Structural problems in oncology—Problem #4: The burden of payment is not matched with those making treatment decisions [54:45]; “No-brainer” moves in oncology [1:06:45]; “Fool’s gold” treatments in oncology [1:09:30]; The six hallmarks of successful cancer policy [1:16:00]; Cancer policy hallmark #1: Independence [1:18:00]; Cancer policy hallmark #2: Evidence [1:28:15]; Cancer policy hallmark #3: Relevance [1:31:30]; Cancer policy hallmark #4: Affordability [1:32:00]; Cancer policy hallmark #5: Possibility [1:47:00]; Cancer policy hallmark #6: Agenda [1:52:00]; Tumor genome sequencing and liquid biopsies [1:54:30]; Vinay’s clinical philosophy, being skeptical without being too contrarian, and practicing medicine without perfect information [2:03:30]; and More. Learn more: https://peterattiamd.com/

    Show notes page for this episode: https://peterattiamd.com/VinayPrasad 

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    • 2 hrs 12 min

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